Editor's Commentary - The influence of family history on prostate cancer risk: Implications for clinical management

BERKELEY, CA (UroToday.com) - In the online edition of the British Journal of Urology International, a group of prominent European investigators report on the influence of family history on prostate cancer (CaP) risk. While it is known that family history increases the risk of CaP by 2.5-4.0 fold, they felt that in routine clinical practice it should be given more consideration alongside PSA for Cap risk assessment. They review some of the data.

They state that 5-10% of CaP cases are caused by dominantly inherited susceptibility to the disease. Statistically significant effects of heritable factors were observed to CaP, with inherited genes contributing 42% to the total risk of developing CaP and unique environmental factors making up the other 58% of the risk. In addition, single nucleotide polymorphisms (SNPs) additively with family history can identify up to a 9-fold increased risk of CaP. However, most data does not suggest that there is a significant difference between familial and sporadic forms for CaP for clinicopathological features, treatment response, or outcomes. The lifetime risk for developing CaP increases from 12% for a man with a father affected at >60 years of age to 35-45% for a man with 3 or more affected male relatives. In comparison, a man with no family history has an 8% lifetime risk of developing CaP. Meta-analyses reported a pooled relative risk of 1.93 for men with a history of CaP in any relative, increasing as the degree of relatedness increased. Other studies showed that the relative risk increased from 1.78-1.84 with only a father or brother afflicted to 2.34 if both had CaP. The risk was higher if the relative was diagnosed younger than age 60. A Swedish family cancer database also supported these observations, with an HR=23 if men aged <65 years had 3 affected brothers with CaP. An affected brother conferred a higher risk than an affected father. Data from the control arm of the PCPT trial also supported that a positive family history was statistically significantly associated with an increased risk of CaP.

The authors conclude that there is a large body of evidence supporting that men with a family history of CaP are at increased risk of developing CaP compared with men with no family history. It should be taken into account in the clinical setting when a patient’s risk for developing CaP is being assessed.

Madersbacher S, Alcaraz A, Emberton M, Hammerer P, Ponholzer A, Schröder FH, Tubaro A

BJU Int. 2011 Mar;107(5):716-721

PubMed Abstract
PMID: 21166744

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