Lifestyle recommendations to prevent prostate cancer, part I: time to redirect our attention?

Molecular Mechanisms and Bioavailability of Polyphenols in Prostate Cancer

Prostate cancer is the one of the most frequently diagnosed cancers among men over the age of 50. Several lines of evidence support the observation that polyphenols have preventive and therapeutic effects in prostate cancer. Moreover, prostate cancer is ideal for chemoprevention due to its long latency. We propose here an equilibrated lifestyle with a diet rich in polyphenols as prophylactic attempts to slow down the progression of localized prostate cancer or prevent the occurrence of the disease. In this review, we will first summarize the molecular mechanisms of polyphenols in prostate cancer with a focus on the antioxidant and pro-oxidant effects, androgen receptors (AR), key molecules involved in AR signaling and their transactivation pathways, cell cycle, apoptosis, angiogenesis, metastasis, genetic aspects, and epigenetic mechanisms. The relevance of the molecular mechanisms is discussed in light of current bioavailability data regarding the activity of polyphenols in prostate cancer. We also highlight strategies for improving the bioavailability of polyphenols. We hope that this review will lead to further research regarding the bioavailability and the role of polyphenols in prostate cancer prevention and treatment.

The impact of nutrition in urogenital cancers

Prostate, bladder and kidney cancers remain the most common cancers of the urinary tract. Despite improved primary prevention, detection and treatment, the incidence of age-related cancers of the urinary tract is likely to rise as a result of global population ageing. An association of diet with prostate, bladder and kidney carcinogenesis is plausible since the majority of metabolites, including carcinogens, are excreted through the urinary tract. Moreover, large regional differences in incidence rates of urologic tumours exist throughout the world. These rates change when people relocate to different geographic areas, which is suggestive of a strong environmental influence. As a result of these observations, numerous studies have been conducted to assess the effects of diet and nutritional status in kidney, bladder and prostate carcinogenesis. Here, we review the literature assessing the effect of diet and nutritional status on urological cancer risk, which has attracted the most interest.

Anticancer activity of green tea polyphenols in prostate gland

Numerous evidences from prevention studies in humans, support the existence of an association between green tea polyphenols consumption and a reduced cancer risk. Prostate cancer is one of the most frequently diagnosed male neoplasia in the Western countries, which is in agreement with this gland being particularly vulnerable to oxidative stress processes, often associated with tumorigenesis. Tea polyphenols have been extensively studied in cell culture and animal models where they inhibited tumor onset and progression. Prostate cancer appears a suitable target for primary prevention care, since it grows slowly, before symptoms arise, thus offering a relatively long time period for therapeutic interventions. It is, in fact, usually diagnosed in men 50-year-old or older, when even a modest delay in progression of the disease could significantly improve the patients quality of life. Although epidemiological studies have not yet yielded conclusive results on the chemopreventive and anticancer effect of tea polyphenols, there is an increasing trend to employ these substances as conservative management for patients diagnosed with less advanced prostate cancer. Here, we intend to review the most recent observations relating tea polyphenols to human prostate cancer risk, in an attempt to outline better their potential employment for preventing prostate cancer.

Statins and prostate cancer: molecular and clinical aspects

The field of the potential applications of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) beyond their unambiguous cardiovascular beneficial effects is steadily increasing. In this regard, statins have also been shown to possess anti-inflammatory, immunomodulatory, antioxidant and growth inhibitory properties. Regarding their role in carcinogenesis, both preclinical and clinical studies report conflicting results. Intriguingly, accumulating evidence suggests that statins may relate to decreased prostate cancer incidence and recurrence risk. However, data from clinical studies seem to be still weak and are confounded by several factors. Nonetheless, preclinical data suggest that statins might exert a chemopreventive role against prostate cancer by inhibiting the proliferation and inducing apoptosis of prostate cancer cells and also inhibiting angiogenesis, inflammation and metastasis. Cholesterol lowering as well as statin pleiotropy through inhibition of the synthesis of isoprenoids have both been implicated in their anticancer properties. In this review, we discuss the preclinical and clinical evidence supporting the preventive or potentially harmful effects of statins on prostate tumourigenesis and conclude that statins should not be recommended for the prevention of prostate cancer development or progression based on the current data.

Selenium-responsive proteins in the sera of selenium-enriched yeast-supplemented healthy African American and Caucasian men

BACKGROUND

Studies have shown that supplementation of adult men with selenium-enriched yeast (SY) was protective against prostate cancer (PCa) and also reduced oxidative stress and levels of prostate-specific antigen. Here, we determined the effect of SY supplementation on global serum protein expression in healthy men to provide new insights into the mechanism of selenium chemoprevention; such proteins may also serve as biomarkers of disease progression.

METHODS

Serum samples from 36 adult men were obtained from our previous SY clinical trial, 9 months after supplementation with either SY (247 microg/d; n = 17) or placebo (nonenriched yeast; n = 19).

RESULTS

Proteomic profiling using two-dimensional difference in gel electrophoresis followed by liquid chromatography-tandem mass spectrometry revealed a total of 1,496 candidate proteins, of which, 11 were differentially expressed in the SY group as compared with placebo. Eight proteins were upregulated [clusterin isoform 1 (CLU), transthyretin, alpha-1B-glycoprotein, transferrin, complement component 4B proprotein, isocitrate dehydrogenase, haptoglobin, and keratin 1] and three proteins were downregulated [alpha-1 antitrypsin (AAT), angiotensin precursor, and albumin precursor] by SY. All of the identified proteins were redox-sensitive or involved in the regulation of redox status. Because both AAT and CLU have been previously linked to PCa development, their identities were confirmed by two-dimensional Western blot analysis.

CONCLUSIONS

We identified AAT and CLU as potential candidate proteins involved in the mechanism of PCa prevention by SY. Collectively, proteins identified in this study might serve as potential new biomarkers for monitoring and comparing responses to selenium-based chemopreventive agents.

IMPACT

Proteomic analysis of serum might be useful for the early detection and monitoring efficacy of chemopreventive agents.

Oxidative stress and DNA methylation in prostate cancer

The protective effects of fruits, vegetables, and other foods on prostate cancer may be due to their antioxidant properties. An imbalance in the oxidative stress/antioxidant status is observed in prostate cancer patients. Genome oxidative damage in prostate cancer patients is associated with higher lipid peroxidation and lower antioxidant levels. Oxygen radicals are associated with different steps of carcinogenesis, including structural DNA damage, epigenetic changes, and protein and lipid alterations. Epigenetics affects genetic regulation, cellular differentiation, embryology, aging, cancer, and other diseases. DNA methylation is perhaps the most extensively studied epigenetic modification, which plays an important role in the regulation of gene expression and chromatin architecture, in association with histone modification and other chromatin-associated proteins. This review will provide a broad overview of the interplay of oxidative stress and DNA methylation, DNA methylation changes in regulation of gene expression, lifestyle changes for prostate cancer prevention, DNA methylation as biomarkers for prostate cancer, methods for detection of methylation, and clinical application of DNA methylation inhibitors for epigenetic therapy.

Prostate-specific natural health products (dietary supplements) radiosensitize normal prostate cells

PURPOSE

Prostate-specific health products (dietary supplements) are taken by cancer patients to alleviate the symptoms linked with poor prostate health. However, the effect of these agents on evidence-based radiotherapy practice is poorly understood. The present study aimed to determine whether dietary supplements radiosensitized normal prostate or prostate cancer cell lines.

METHODS AND MATERIALS

Three well-known prostate-specific dietary supplements were purchased from commercial sources available to patients (Trinovin, Provelex, and Prostate Rx). The cells used in the study included normal prostate lines (RWPE-1 and PWR-1E), prostate tumor lines (PC3, DU145, and LNCaP), and a normal nonprostate line (HaCaT). Supplement toxicity was assessed using cell proliferation assays [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] and cellular radiosensitivity using conventional clonogenic assays (0.5-4Gy). Cell cycle kinetics were assessed using the bromodeoxyuridine/propidium iodide pulse-labeling technique, apoptosis by scoring caspase-3 activation, and DNA repair by assessing gammaH2AX.

RESULTS

The cell growth and radiosensitivity of the malignant PC3, DU145, and LNcaP cells were not affected by any of the dietary prostate supplements (Provelex [2 microg/mL], Trinovin [10 microg/mL], and Prostate Rx [50 microg/mL]). However, both Trinovin (10 microg/mL) and Prostate Rx (6 microg/mL) inhibited the growth rate of the normal prostate cell lines. Prostate Rx increased cellular radiosensitivity of RWPE-1 cells through the inhibition of DNA repair.

CONCLUSION

The use of prostate-specific dietary supplements should be discouraged during radiotherapy owing to the preferential radiosensitization of normal prostate cells.

Review of exercise and the risk of benign prostatic hyperplasia

It has been long appreciated that a healthy lifestyle plays a critical role in cardiovascular health. It is now apparent that the same is true in the development of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Since 1995, 14 studies have been identified that investigate the clinical relationship between exercise and BPH/LUTS. No randomized controlled trials have been performed, but useful prospective cohort data originating from recent publications on the medical treatment of BPH and prevention of prostate cancer are available. Most of the literature supports a clinically significant, independent, and strong inverse relationship between exercise and the development of BPH/LUTS. Several mechanisms for this relationship have been proposed, including decreased sympathetic tone, avoidance of metabolic syndrome, and reduced oxidative damage to the prostate.

The beliefs, and reported and intended behaviors of unaffected men in response to their family history of prostate cancer

PURPOSE

Genetic testing for hereditary cancer facilitates medical management and improves health outcomes. Genetic testing is not currently available for prostate cancer, but trials are underway to investigate if antiandrogens and selenium have a preventive role for at-risk individuals. To inform future genetic counseling, we sought to understand the pre-existing beliefs and behaviors of men with a family history of prostate cancer and explore their intention to adopt possible preventive behaviors in response to test results.

METHODS

A survey was completed by 280 men (response: 59%).

RESULTS

The belief that diet influenced prostate cancer risk was held by 73% of participants, whereas 37% believed in medication/natural therapies. Thirty-nine percent reported at least one change to their diet, alcohol consumption, smoking, exercise patterns, vitamin/mineral/supplement intake and/or medication/natural therapy in response to their family history. The men expressed interest in genetic testing with 92% "definitely" or "probably" interested. Definite interest was associated with number of affected relatives and prostate cancer-related anxiety. A positive genetic test would motivate 93% of men to make at least one behavioral change.

CONCLUSIONS

Participants commonly believed behavioral factors influenced prostate cancer risk and reported that they would alter their behavior to reduce risk after (hypothetical) genetic testing.

The effect of dietary supplementation with limonene or myo-inositol on the induction of neoplasia and matrix metalloproteinase and plasminogen activator activities in accessory sex organs of male Lobund-Wistar rats

Prostate cancer, the most prevalent non-cutaneous cancer in men, is associated with increased age. This suggests that dietary chemopreventive measures could be effective in delaying the onset or decreasing the severity of the disease. We utilized the Lobund-Wistar rat nitrosomethylurea induced, testosterone promoted (NMU-T) model of male sex accessory gland cancer to test the potential chemopreventive effects of myo-inositol and limonene on tumor incidence and associated protease activities. Tumors were found to arise in the seminal vesicles and dorsal and anterior prostate lobes. There were also some tumors that appeared to arise in both the seminal vesicles and anterior prostate, and in some cases the tissue of origin was not clear. The distribution of tumors as to site of origin in limonene or myo-inositol treated animals did not vary from that of the starch fed control animals, and the number of animals presenting with metastases did not vary significantly between treatment groups. There was a statistically significant delay in onset of tumors in myo-inositol, but not limonene fed rats, at 10 months post-induction of carcinogenesis; however, at 12 and 15 months this was not significant. The ventral prostate and seminal vesicles expressed pro-MMP-2 and plasminogen activator (PA) activities. Based on sensitivity to amiloride, the PA activities were predominately urokinase (uPA) in the ventral prostate and a mixture of tissue-type activator (tPA) and uPA in the seminal vesicles of non-treated rats. Sex accessory gland tumors, and metastases, expressed increased levels PA and pro- and active forms of MMP-2 and -9. The PA activities of the tumors were a mixture of uPA and tPA. There was no difference in the levels of these protease activities based on the tissue of tumor origin, nor in tumor vs metastasis. These studies indicate that MMP and PA activities play a role in sex accessory gland tumor biology and that dietary supplementation with myo-inositol can delay but not ultimately prevent the development of such tumors.

Clinical events in prostate cancer lifestyle trial: results from two years of follow-up

OBJECTIVES

Previous research has demonstrated that patients with prostate cancer participating in the Prostate Cancer Lifestyle Trial had a reduction in prostate-specific antigen (PSA) levels, inhibition of LNCaP cell growth, and fewer prostate cancer-related clinical events at the end of 1 year compared with controls. The aim of this study was to examine the clinical events in this trial during a 2-year period.

METHODS

The Prostate Cancer Lifestyle Trial was a 1-year randomized controlled clinical trial of 93 patients with early-stage prostate cancer (Gleason score <7, PSA 4-10 ng/mL) undergoing active surveillance. The patients in the experimental arm were encouraged to adopt a low-fat, plant-based diet, to exercise and practice stress management, and to attend group support sessions. The control patients received the usual care.

RESULTS

By 2 years of follow-up, 13 of 49 (27%) control patients and 2 of 43 (5%) experimental patients had undergone conventional prostate cancer treatment (radical prostatectomy, radiotherapy, or androgen deprivation, P < .05). No differences were found between the groups in other clinical events (eg, cardiac), and no deaths occurred. Three of the treated control patients but none of the treated experimental patients had a PSA level of >or=10 ng/mL, and 1 treated control patient but no treated experimental patients had a PSA velocity of >2 ng/mL/y before treatment. No significant differences were found between the untreated experimental and untreated control patients in PSA change or velocity at the end of 2 years.

CONCLUSIONS

Patients with early-stage prostate cancer choosing active surveillance might be able to avoid or delay conventional treatment for at least 2 years by making changes in their diet and lifestyle.

Prostate Cancer - What's New?

Research has shown that prostate specific antigen (PSA) is a tumour marker for diagnosis of cancer prostate with significant prognostic value. Screening studies in North America and Europe have revealed that carcinoma prostate is common. Early detection and treatment improves the quality of life besides preventing deaths due to metastatic prostate cancer. Radical prostatectomy and laparoscopic radical prostatectomy has become the standard treatment for localized prostate cancer in all major uro-oncological centres resulting in reduced mortality. Magnetic resonance imaging and positron emission tomography have helped in detecting local and distant spread of cancer prostate. Revised approach to reduce occurrence of prostate cancer by the use of 5 alpha reductase inhibitors like finasteride and dietary supplements has been instituted. The World Health Organisation (WHO) has recommended lifestyle changes to promote men's health and reduce the incidence of prostate cancer.

Dietary agents in the chemoprevention of prostate cancer

Nutritional factors have been estimated to contribute 20-60% of cancers around the globe, and almost one-third of deaths are being reported in Western countries. According to estimates by the American Cancer Society, during the year 2005 about 232,090 new cases of prostate cancer will be diagnosed alone in the United States and 30,350 men will die of this disease. The high incidence and long latency period of prostate cancer offer plenty of time to pursue strategies toward prevention and/or treatment to suppress or revert this disease. Epidemiological evidence suggests that plant-based dietary agents decrease the risk of some types of human cancer, including prostate cancer. Intake of 400-600 g/day of fruits and vegetables is associated with reduced risk of several cancers. The use of micronutrients and/or other phenolic agents in the diet or synthetic exogenous supplements to prevent neoplastic transformation of normal cells or to slow the progression of established malignant changes in cancer cells is termed "chemoprevention." Considerable attention has been devoted to identify plant-based dietary agents that may serve as natural inhibitors of prostate carcinogenesis. Much progress has been made in the last decade in this area of investigation through identification of pathways that play important roles in prostate tumorigenesis. This article summarizes epidemiological, clinical, and mechanistic studies and the significance of plant-derived dietary agents such as flavonoids, indoles, isothiocyanates, phenolics, monoterpenes, and complementary and alternative agents in the management of prostate cancer with recommendations for future studies to advance this area of research.

Impact of diet on prostate cancer: a review

Epidemiological studies suggest that environmental factors may mediate the transformation of latent prostate cancer into clinically apparent tumors and that diet appears to influence this progression. Close correlations between average per capita fat intake and prostate cancer mortality internationally generated interest in underlying mechanisms for this link, such as through serum levels of androgens, free radicals, proinflammatory fatty acid metabolites, or insulin-like growth factor. Much interest currently lies in the potential of HMG-CoA reductase inhibitors (statins) to play a chemopreventative role in prostate cancer. Lycopene, a potent antioxidant found in tomatoes, may exert a protective effect in the prostate. Selenium and vitamin E have also been shown to decrease the risk of prostate cancer in some men. Calcium may support vitamin D-related antiproliferative effects in prostate cancer. Certain soy proteins, common in the Asian diet, have been shown to inhibit prostate cancer cell growth. Finally, green tea may also have a chemopreventive effect by inducing apoptosis. Despite confounding factors present in clinical studies assessing the effect of diet on cancer risk, the data remain compelling that a variety of nutrients may prevent the development and progression of prostate cancer.

Complementary and alternative medicine in urology

Complementary and alternative medicine (CAM) includes various practices, measures and products which are not presently considered to be a part of conventional (mainstream) medicine. Herbal products, vitamins, minerals and amino acids are increasingly popular as dietary supplements for the treatment, improvement and prophylaxis of urological diseases, and to improve general health and well-being. As these products are freely available without prescription, conventional healthcare providers are often unaware that their patients are using CAM. It is essential to know that some herbal supplements may act in the same way as chemical drugs, and that they originate 'from nature' does not mean that they are safe and/or with no potential harmful effects and/or toxicity. Eventual interactions with conventional medications and contamination with prescription drugs and metals have been reported. The active components of many phytotherapeutic preparations and their mechanism(s) of action are still being determined and evaluated. There is scientific evidence for the effectiveness of some CAM treatments, but for most there are important key questions yet to be answered through basic research and well-designed studies according to established guidelines. Because of the increasing popularity and use of CAM, conventional healthcare providers, including urologists, should not ignore it, and be well informed about the benefits and potential risks of dietary supplements, so that they can advise their patients about this developing field. Whenever necessary and possible, lifestyle and behavioural changes should be recommended before using CAM, and eventually be supplemented by CAM as a second step.

Heart healthy equals prostate healthy equals statins: the next cancer chemoprevention trial. Part I

PURPOSE OF REVIEW

Several important observations should be kept in mind by cancer researchers: cardiovascular disease (CVD) is the number one cause of death; CVD is the number one cause of death in the largest cancer chemoprevention trials; CVD is the number one or two cause of death in prostate cancer patients; and some of the mechanisms that increase the risk of CVD may also increase the risk or progression of prostate cancer.

RECENT FINDINGS

Screening studies suggest a high prevalence of dyslipidemia in men with and without prostate cancer. Numerous recent lifestyle interventions that reduce cholesterol have also been found to have a potential impact on reducing the risk of prostate cancer. Recent studies of statins and other heart healthy agents have found a secondary potential for exhibiting a reduced risk or progression of prostate cancer.

SUMMARY

Laboratory and clinical data over the past several decades continue to support the use of a heart healthy agent in the nest cancer chemoprevention trial. The potential for an agent to simultaneously reduce the risk of the primary and secondary cause of death suggests that statins and other heart healthy agents are the ideal next interventions to be utilized in the next major cancer chemoprevention trial. If successful, this agent would most likely represent a dramatic impact on the history of cancer chemoprevention, and if not successful the potential secondary impact would again be a landmark finding in cancer chemoprevention; so the time is more than ripe for such a unique trial.

Promoting general health during androgen deprivation therapy (ADT): a rapid 10-step review for your patients

Androgen deprivation for prostate cancer use to be applied only in the latter stage of the disease process, thus, the issue of promoting general health during this time was not a concern because the subject of life and death was more paramount. However, thanks to earlier detection of prostate cancer, there has been a general stage migration in this disease. Men are choosing these traditionally late stage therapies earlier and earlier. Therefore, the subject of quality of life on this treatment has now garnered as much attention as the survival issues. Cognitive or mental health concerns, cholesterol changes, hot flashes, osteoporosis, and other side effects are being addressed and treated with a variety of conventional medicines. However, the issue of the role of the patient or what men can do personally to promote better mental and physical health is desperately needed in this area. A variety of beneficial lifestyle changes and over-the-counter agents may have an enormous impact on men's health during androgen deprivation. Calcium and vitamin D supplements, aerobic and resistance exercise, cholesterol awareness and reduction, weight loss, and other individual changes could have an enormous impact on the quality and quantity of a man's life. Some of these so called "bottom line" recommendations are reviewed in this article to empower the patient during this time, and to send clearly the message that he has a role to play apart from just picking up and using a prescription drug for side effects, and his role is just as critical for improving the probability of living longer and better.

Heart healthy equals prostate healthy equals statins: the next cancer chemoprevention trial. Part II

PURPOSE OF REVIEW

Specific ongoing observations from diverse medical studies do not serve to belittle the impact of prostate or other cancers, but the overall impact of cardiovascular disease (CVD) in individuals at high-risk or in individuals that have been diagnosed with common cancers needs to be addressed by future research. CVD has been the number one cause of death in men and women since the year 1990. Serum cholesterol levels are some of the most accurate long-term predictors of all-cause mortality. CVD has been the number one cause of death in the largest dietary supplement cancer chemoprevention trials.

RECENT FINDINGS

The potential for utilizing a cancer chemoprevention agent that may simultaneously reduce the risk of CVD and cancer is not only attractive, but several agents are available immediately that may demonstrate this unique impact. For example, recently statin drugs, low-dose aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), and even fish oil supplements may be utilized in the next major cancer chemoprevention trial.

SUMMARY

Heart healthy agents and interventions seem to also exhibit the ability to be prostate healthy. In addition, their low cost and potential to reduce all-cause mortality may also ensure good compliance. Statins and other heart healthy agents should be considered to be the next most ideal interventions to be utilized in the next major chemoprevention trial, especially now because several popular past dietary supplements and drugs have demonstrated the potential for notable side effects and an inability to impact the risk of CVD.

Why a statin and/or another proven heart healthy agent should be utilized in the next major cancer chemoprevention trial: Part I

The recent removal of refecoxib (a cyclo-oxygenase II inhibitor), a drug involved in a large prostate cancer chemoprevention trial, and the completion of recruitment for the SELECT cancer chemoprevention trial utilizing selenium and vitamin E should lead researchers to ponder a similar question in cancer chemoprevention. The question of "What agent should be utilized and what clinical trial should designed and conducted next for cancer chemoprevention?" Part I and II of this manuscript attempts to argue that statins or cholesterol-lowering drugs or heart healthy agents are the ideal next choice for a large chemoprevention trial for numerous reasons including: (1) Cardiovascular disease (CVD) has been the number one cause of death in men and women every year in the US since 1900; (2) CVD has been the number one cause of death in the major cancer chemoprevention trials; (3) CVD has been the number one or two cause of death of men and women postdiagnosis of breast, colorectal, and prostate cancer; and (4) the recent potential relationship between certain cancers and dyslipidemia needs to be investigated. What other chemoprevention agent can also boast that in the worst case scenario the number one cause of death in men and women would probably be reduced in this future cancer chemoprevention trial of statins?! The list continues to grow of cancer chemoprevention trials that will probably be either a complete hit or miss. In other words, they will or have reduced the disease of interest with virtually no potential role for reducing the number one cause of death in men and women. The time seems more than overdue for a statin and/or another cholesterol lowering or heart healthy cancer chemoprevention trial.

Neoadjuvant and adjuvant chemotherapy for high-risk localized prostate cancer

The optimal treatment strategy for patients with high-risk localized prostate cancer remains unknown. Definitive local treatments such as radical prostatectomy and external beam radiotherapy cure only a minority of these patients. Recent efforts have been made to reduce the risk of recurrence and delay progression to symptomatic hormone-refractory disease by using chemotherapy before, during, or after definitive local therapy. Chemotherapy is an effective modality in the treatment of hormone- refractory prostate cancer. Studies have established its role in the palliation of symptoms in patients with hormone-refractory disease, though a survival benefit remains to be demonstrated. Prospective randomized trials are underway to test the hypothesis that neoadjuvant and adjuvant chemotherapy may improve survival rate in patients with high-risk localized prostate cancer. The data currently available from nonrandomized trials have not yet established the exact role of neoadjuvant and adjuvant chemotherapy and its potential impact on survival. However, preliminary data suggest that chemotherapy, when administered in concert with definitive local therapy, may be promising in patients with locally advanced prostate cancer. Randomized clinical trials are ongoing to see if neoadjuvant and adjuvant chemotherapy will translate into an improved clinical benefit for the patient, and participation by patients is paramount. We review the recent literature regarding the use of neoadjuvant and adjuvant chemotherapy in patients with locally advanced prostate cancer.