The impact of germline mutations associated with hereditary cancer syndromes in patients on active surveillance (AS) for prostate cancer is poorly defined. We examined the association between family history of prostate cancer (FHP) or family history of cancer (FHC) and risk of progression or adverse pathology at radical prostatectomy (RP) in patients on AS.
Patients on AS at a single tertiary-care center between 2000-2019 were categorized by family history. Disease progression was defined as an increase in Gleason grade on biopsy. Adverse pathology was defined as upgrading/upstaging at RP. Multivariable Cox and logistic regression models were used to assess association between family history and time to progression or adverse pathology, respectively.
Among 3211 evaluable patients, 669 (21%) had FHP, 34 (1%) had FHC, and 95 (3%) had both; 753 progressed on AS and 481 underwent RP. FHP was associated with increased risk of progression (HR 1.31; 95% CI, 1.11-1.55; p=0.002), but FHC (HR 0.67; 95% CI, 0.30-1.50; p=0.3) or family history of both (HR 1.22; 95% CI, 0.81-1.85; p=0.3) were not. FHP, FHC, or both were not associated with adverse pathology at RP (p>0.4).
While FHP was associated with an increased risk of progression on AS, wide confidence intervals render this outcome of unclear clinical significance. FHC was not associated with risk of progression on AS. In the absence of known genetically defined hereditary cancer syndrome, we suggest FHP and/or FHC should not be used as a sole trigger to preclude patients from enrolling on AS.
The Journal of urology. 2022 Apr 04 [Epub ahead of print]
Ghalib A Jibara, Marlon Perera, Emily A Vertosick, Daniel D Sjoberg, Andrew Vickers, Peter T Scardino, James A Eastham, Vincent P Laudone, Karim Touijer, Xin Lin, Maria I Carlo, Behfar Ehdaie
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.