Randomized trial finds that prostate cancer genetic risk score feedback targets prostate-specific antigen screening among at-risk men.

Prostate-specific antigen (PSA) screening may reduce death due to prostate cancer but leads to the overdiagnosis of many cases of indolent cancer. Targeted use of PSA screening may reduce overdiagnosis. Multimarker genomic testing shows promise for risk assessment and could be used to target PSA screening.

To test whether counseling based on the family history (FH) and counseling based on a genetic risk score (GRS) plus FH would differentially affect subsequent PSA screening at 3 months (primary outcome), a randomized trial of FH versus GRS plus FH was conducted with 700 whites aged 40 to 49 years without prior PSA screening. Secondary outcomes included anxiety, recall, physician discussion at 3 months, and PSA screening at 3 years. Pictographs versus numeric presentations of genetic risk were also evaluated.

At 3 months, no significant differences were observed in the rates of PSA screening between the FH arm (2.1%) and the GRS-FH arm (4.5% with GRS-FH vs. 2.1% with FH: χ(2) = 3.13, P = .077); however, PSA screening rates at 3 months significantly increased with given risk in the GRS-FH arm (P = .013). Similar results were observed for discussions with physicians at 3 months and PSA screening at 3 years. Average anxiety levels decreased after the individual cancer risk was provided (P = .0007), with no differences between groups. Visual presentation by pictographs did not significantly alter comprehension or anxiety.

This is likely the first randomized trial of multimarker genomic testing to report genomic targeting of cancer screening. This study found little evidence of concern about excess anxiety or overuse/underuse of PSA screening when multimarker genetic risks were provided to patients. Cancer 2016. © 2016 American Cancer Society.

Cancer. 2016 Jul 19 [Epub ahead of print]

Aubrey R Turner, Brian R Lane, Dan Rogers, Isaac Lipkus, Kathryn Weaver, Suzanne C Danhauer, Zheng Zhang, Fang-Chi Hsu, Sabrina L Noyes, Tamara Adams, Helga Toriello, Thomas Monroe, Trudy McKanna, Tracey Young, Ryan Rodarmer, Richard J Kahnoski, Mouafak Tourojman, A Karim Kader, S Lilly Zheng, William Baer, Jianfeng Xu

Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina., Spectrum Health Hospital System, Grand Rapids, Michigan., Van Andel Research Institute, Grand Rapids, Michigan., School of Nursing, Duke University, Durham, North Carolina., Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina., Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina., Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina., Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina., Spectrum Health Hospital System, Grand Rapids, Michigan., Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina., Spectrum Health Hospital System, Grand Rapids, Michigan., Spectrum Health Hospital System, Grand Rapids, Michigan., Spectrum Health Hospital System, Grand Rapids, Michigan., Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina., Spectrum Health Hospital System, Grand Rapids, Michigan., Spectrum Health Hospital System, Grand Rapids, Michigan., Spectrum Health Hospital System, Grand Rapids, Michigan., Department of Surgery, University of California San Diego, San Diego, California., Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina., Grand Valley Medical Specialists, Grand Rapids, Michigan., Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina.