EAU 2017: Prostate cancer screening in high risk families: Should PSA testing be performed yearly in first degree relatives with baseline PSA ≤1ng/ml?

London, England (UroToday.com) As family history, specifically a first-degree relative (FDR) – brother or father, is a known risk factor for prostate cancer development, further clarifying the appropriate assessment of these FDR’s is important.

In this study, the authors aimed to assess the risk of prostate cancer development in a younger patient population who have known FDRs with prostate cancer. Specifically, they identified 660 men with known FDR with prostate cancer and invited them into a pre-specified 8-year screening program - 345 men aged 40-49 and 315 aged 50-75. A systematic genealogical analysis was previously performed – all had at least 1 PCa in the family (range: 1-7): Hereditary status (3+ CaP; 10.15%), familial without obvious hereditary pattern (2CaP; 18,5%) or sporadic (1CaP; 71.8%).

All men had annual PSA screens. The trigger for biopsy was PSA >4ng/mL until 2002, but was changed to PSA >2.5ng/mL thereafter.

Of the 660 FDR, 331 (50.1%, med. age: 48y) had a PSA level ≤1ng/ml at baseline. Of these 331 men, 210 were aged 40-49 (med age 44y) while 121 were aged 50-70 (med age 56y). Through the 8 years, approximately 70% were followed through 7 year, but only 50% made it to the 8th year.

Fifteen patients met the biopsy criteria. The breakdown is seen below:

Only two cases of PCa were found – one in year 5 and the other in year 8. Both were not insignificant – cT3a Gleason 4+3 @ 5 years, cT2c Gleason 3+3 @ 8 years. Also, at least 9 men who met criteria refused biopsy.

Despite its drawbacks, this study demonstrates that young patients, despite having FDR with PCa, if their PSA < 1, they can be followed with PSA screens every 5 years. Obviously, limitations include the 9 patients that refused biopsy (undiagnosed prostate cancer) and short follow-up of 8 years (predetermined).

Presented by: P. Callerot

Co-authors: Moineau M-P., Cussenot I., Baschet F., L' Her J., Doucet L., Cancel-Tassin G., Cormier L., Mangin P., Cussenot O., Fournier G., Valeri A.

1. Brest University Hospital, Dept. of Urology, Brest, France
2. Brest University Hospital, Nuclear Medecine Laboratory, Brest, France
3. Tenon University Hospital, CeRePP (Centre De Recherche Sur Les Pathologies Prostatiques), Paris, France
4. Dijon University Hospital, Dept. of Urology, Dijon, France, 5Tenon University Hospital, Dept. of Urology, Paris, France

Written by: Thenappan Chandrasekar , Clinical Fellow, University of Toronto
Twitter: @tchandra_uromd

at the #EAU17 -March 24-28, 2017- London, England