Tiwari R, Fleshner N, et al. - In view of an emerging sound scientific basis on the anti-neoplastic role of metformin, statins and dietary interventions, this overview was performed to analyze the rationale for metformin, statins and dietary intervention for secondary prevention in men on active surveillance for prostate cancer.

• From Pubmed, MEDLINE, EMBASE and Cochrane library, a total of 14 trials on metformin, 21 trials on statins and 13 trials on dietary measures were analyzed; majority were observational population-based cohort studies or meta-analysis of them.

• Overall, mixed results were provided, but a promising role of metformin and statins is indicated in several trials demonstrating decreased rates of progression and cancer specific mortality.

• Combination therapy strategies have also been assessed in more advanced cases demonstrating synergism.

• Some benefit was shown to be afforded by dietary interventions especially fruits, vegetables and fish consumption, but mixed results were obtained for others like legumes, red meat, coffee and multivitamins.

• Various ongoing randomized trials would offer more robust evidence in the future for secondary prevention.