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A positive family history as risk factor for prostate cancer in a population-based study with organized PSA-screening: results of the Swiss ERSPC (Aarau)


Randazzo, Marco; Müller, Alexander; Carlsson, Sigrid; Eberli, Daniel; Huber, Andreas; Grobholz, Rainer; Manka, Lukas; Mortezavi, Ashkan; Sulser, Tullio; Recker, Franz; Kwiatkowski, Maciej (2016). A positive family history as risk factor for prostate cancer in a population-based study with organized PSA-screening: results of the Swiss ERSPC (Aarau). BJU International, 117(4):576-583.

Abstract

OBJECTIVE: To assess the value of positive family history (FH) as a risk factor for prostate cancer (PCa) incidence and grade among men undergoing organized PSA-screening in a population-based study.
PATIENTS AND METHODS: The study cohort comprised all attendees of the Swiss arm of the ERSPC with systematic PSA-tests every 4 years. Men reporting first-degree relative(s) diagnosed with PCa were considered to have a positive FH. Biopsy was exclusively PSA-triggered with a threshold of 3ng/ml. Primary endpoint was PCa diagnosis. Kaplan-Meier and Cox regression analyses were used.
RESULTS: Of 4,932 attendees with a median age of 60.9 (IQR 57.6-65.1) years, 334 (6.8%) reported a positive FH. Median follow-up duration was 11.6 years (IQR 10.3-13.3). Cumulative PCa incidence was 60/334 (18%, positive FH) and 550/4,598 (12%, negative FH) (OR 1.6, 95%CI 1.2-2.2, p=0.001), respectively. In both groups, most PCa diagnosed had a low grade. There were no significant differences of PSA at diagnosis, biopsy Gleason score or Gleason score on pathologic specimen among men who underwent radical prostatectomy between both groups, respectively. On multivariable analysis, age (HR 1.04, 95% CI 1.02-1.06), baseline PSA (HR 1.13 95% CI 1.12-1.14), and FH (HR 1.6, CI 1.24-2.14) were independent predictors for overall PCa incidence (p<0.0001 each). Only baseline PSA (HR 1.14, 95%CI 1.12-1.16, p<0.0001) was an independent predictor of Gleason score ≥7 PCa on prostate biopsy. The proportion of interval PCa diagnosed in between the screening rounds was non-significantly different.
CONCLUSION: Irrespective of the FH status, the current PSA-based screening setting detects the majority of aggressive PCa and missed only a minority of interval cancers with a 4-year screening algorithm. Our results suggest that men with a positive FH are at increased risk for low grade but not aggressive PCa. This article is protected by copyright. All rights reserved.

Abstract

OBJECTIVE: To assess the value of positive family history (FH) as a risk factor for prostate cancer (PCa) incidence and grade among men undergoing organized PSA-screening in a population-based study.
PATIENTS AND METHODS: The study cohort comprised all attendees of the Swiss arm of the ERSPC with systematic PSA-tests every 4 years. Men reporting first-degree relative(s) diagnosed with PCa were considered to have a positive FH. Biopsy was exclusively PSA-triggered with a threshold of 3ng/ml. Primary endpoint was PCa diagnosis. Kaplan-Meier and Cox regression analyses were used.
RESULTS: Of 4,932 attendees with a median age of 60.9 (IQR 57.6-65.1) years, 334 (6.8%) reported a positive FH. Median follow-up duration was 11.6 years (IQR 10.3-13.3). Cumulative PCa incidence was 60/334 (18%, positive FH) and 550/4,598 (12%, negative FH) (OR 1.6, 95%CI 1.2-2.2, p=0.001), respectively. In both groups, most PCa diagnosed had a low grade. There were no significant differences of PSA at diagnosis, biopsy Gleason score or Gleason score on pathologic specimen among men who underwent radical prostatectomy between both groups, respectively. On multivariable analysis, age (HR 1.04, 95% CI 1.02-1.06), baseline PSA (HR 1.13 95% CI 1.12-1.14), and FH (HR 1.6, CI 1.24-2.14) were independent predictors for overall PCa incidence (p<0.0001 each). Only baseline PSA (HR 1.14, 95%CI 1.12-1.16, p<0.0001) was an independent predictor of Gleason score ≥7 PCa on prostate biopsy. The proportion of interval PCa diagnosed in between the screening rounds was non-significantly different.
CONCLUSION: Irrespective of the FH status, the current PSA-based screening setting detects the majority of aggressive PCa and missed only a minority of interval cancers with a 4-year screening algorithm. Our results suggest that men with a positive FH are at increased risk for low grade but not aggressive PCa. This article is protected by copyright. All rights reserved.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Urological Clinic
Dewey Decimal Classification:610 Medicine & health
Date:2016
Deposited On:14 Oct 2015 13:23
Last Modified:21 Nov 2017 18:02
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1464-4096
Additional Information:This is the accepted version of the following article: BJU International, which has been published in final form at http://dx.doi.org/10.1111/bju.13310
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1111/bju.13310
PubMed ID:26332304

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