Controlling exogenous polyamines may be used, in some aspects, as an adjunctive strategy to chemoprevention with polyamine inhibitory agents, for example, anti-carcinoma combination therapies comprising ornithine decarboxylase (ODC) inhibitor and a spermidine/spermine N1-acetyltransferase expression agonist, optionally based on a patient's ODC1 promoter genotype. Assessing a tissue polyamine level or tissue polyamine flux may be used in some aspects, for predicting the efficacy of an anti-carcinoma combination therapy comprising, for example, an ornithine decarboxylase (ODC) inhibitor and an agent that modulates the polyamine pathway to reduce overall cellular polyamine content.