J Urol. 2014 Sep 18. pii: S0022-5347(14)04411-5. doi: 10.1016/j.juro.2014.09.018. [Epub ahead of print]
Incorporation of Detailed Family History from the Swedish Family-Cancer Database into the Prostate Cancer Prevention Trial Risk Calculator.
Detailed family history offers an inexpensive alternative to genetic profiling for individual risk assessment. The objective here was to update the Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) to include detailed family history.
MATERIALS AND METHODS:
Data comprised 55168 prostate cancer cases and 638218 controls from the Swedish Family-Cancer Database who were ≥ 55 years of age in 1999, had at least one male first-degree relative (FDR) ≥ 40 years and one female FDR ≥ 30 years. Likelihood ratios (LR) were computed as the ratio of risk of observing a specific family history pattern in a prostate cancer case compared to control and used to update the PCPTRC.
Having at least one relative with prostate cancer increased the risk of prostate cancer. The LR was 1.63 for one FDR ≥ 60 at diagnosis (10.1% of cancer cases, 6.2% of controls), 2.47 if the relative was < 60 years (1.5% versus 0.6%, respectively), 3.46 for ≥ 2 relatives ≥ 60 years (1.2% versus 0.3%), and 5.68 for ≥ 2 relatives < 60 years (0.05% versus 0.009%). Among men with no diagnosed FDRs, the LR was 1.09 for one or more SDRs diagnosed with prostate cancer (12.7% versus 11.7%, respectively). Additional FDRs with breast cancer or FDRs or SDRs with prostate cancer compounded these risks.
Detailed family history is an independent predictor of prostate cancer to the commonly-used risk factors and should be incorporated into decision-making regarding biopsy. Compared with costly other biomarkers, it is inexpensive and universally available.
Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
digital rectal exam; prostate biopsy; prostate cancer; prostate-specific antigen; self-report family history
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