The potential role of cyclooxygenase-2 inhibitors and 5alpha-reductase inhibitors in the prevention of urologic conditions.

Prevention of urologic cancer is a new field for urology. It focuses attention on men and women who may not be under the regular care of physicians and are without symptoms of disease. Although risk factors (eg, smoking in bladder cancer, family history or African-American ethnicity in prostate cancer, cryptorchid testes in testis cancer, Von Hippel-Lindau disease in renal cell carcinoma) can identify individuals at a greater risk for genitourinary malignancies, most patients have no risk factors except gender and age. Thus, developing public health recommendations that will have a major impact on these diseases will be challenging. Prevention strategies will be held to a higher standard of safety than traditional cancer treatment unless populations at a high risk for disease can be identified. It will be necessary for urologists to monitor the field of disease prevention because of the high frequency of urologic malignancies and the growing elderly population in the United States. Urologists are frequently providers for and confidants of this patient population and must be able to counsel these men and women about the benefits and risks of such prevention strategies.