This article is more than 5 years old. Information may no longer be current.
Age-specific probability of prostate cancer useful when discussing familial risk
Incorporating age-specific probability of non–low- and high-risk prostate cancer as a discussion point in counseling for Swedish men with a family history of the disease is more informative than determining the relative risks of patients developing any prostate cancer.
“We used nationwide, population-based registers to calculate age-specific probabilities of any, non–low-risk, and high-risk prostate cancer for men with and without a known family history of prostate cancer. The probabilities of high-risk prostate cancer were substantially lower than of any prostate cancer,” Ola Bratt, MD, PhD, prostate cancer surgeon in the department of urology at Addenbrooke’s Hospital of Cambridge University, and colleagues wrote.
Guidelines in Europe and the United States recommend PSA testing in men aged 40 to 50 years with a family history of disease. Because families with recently diagnosed men tend to undergo testing immediately after a relative’s diagnosis, however, “the magnitude of the increased prostate cancer risk for men with a family history of prostate cancer is to a large extent inflated by familial aggregation of ‘PSA detected,’ clinically insignificant, low-risk prostate cancer,” Bratt and colleagues wrote.
Researchers studied the brothers of 32,807 men with prostate cancer (n = 51,897).
The population probability of any prostate cancer was 4.8% (95% CI, 4.8-4.9) for men aged 65 years, and 12.9% (95% CI, 12.8-12.9) for men aged 75 years. For non–low-risk prostate cancer, men aged 65 years had a probability of 2.8% (95% CI, 2.7-2.8) and men aged 75 years had a probability of 8.9% (95% CI, 8.8-8.9).
Men with one affected brother had a probability of any prostate cancer of 14.9% (96% CI, 14.1-15.8) at age 65 years. Those aged 75 years had a probability of 30.3% (95% CI, 29.3-31.3).
The probability of non–low-risk disease was 7.3% (95% CI, 6.7-7.9) among men aged 65 years and 18.8% (95% CI, 18.9-19.6) among those aged 75 years.
For high-risk disease, probability was 3% (95% CI, 2.6-3.4) among men aged 65 years and 8.9% (95% CI, 8.2-9.5) among men aged 75 years. The probability for high-risk disease increased to 13.6% (95% CI, 9.9-17.6) for men aged 75 years with more than one affected brother.
“As the probability of any prostate cancer in populations with widespread PSA testing is inflated by clinically insignificant cancer, the probabilities of non–low- and high-risk prostate cancer are more appropriate for counseling men with a family history of prostate cancer,” the researchers wrote. – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.