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Impact of family history on oncological outcomes in primary therapy for localized prostate cancer patients: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2021; 24:638-646. [PMID: 33589769 PMCID: PMC8384618 DOI: 10.1038/s41391-021-00329-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/22/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of family history on oncological outcomes of prostate cancer remains controversial. We conducted a systematic literature review and meta-analysis to investigate the impact of family history of localized prostate cancer on oncological outcomes. METHODS On May 2020, we systematically searched MEDLINE, the Cochrane library, and Scopus for studies that compared patients who had localized prostate cancer with or without a positive family history of prostate cancer. Our aim was to evaluate the association of family history with biochemical recurrence-free survival, cancer-specific survival, and overall survival by means of a multivariate Cox regression analysis. RESULTS Eleven studies with 39,716 patients were included in the systematic review, and eight studies with 33,027 patients for the meta-analysis. A positive family history was not associated with worse biochemical recurrence-free survival (pooled HR: 0.96; 95% CI: 0.79-1.17) or cancer-specific survival (pooled HR: 1.1; 95% CI: 0.52-2.35). Subgroup analyses showed no association between positive family history and poor biochemical recurrence-free survival in prostate cancer patients treated with radical prostatectomy (pooled HR: 0.99; 95% CI: 0.76-1.31) or radiation therapy (pooled HR: 0.93; 95% CI: 0.67-1.30). CONCLUSIONS This meta-analysis indicated that family history of prostate cancer does not increase the risk of biochemical recurrence or cancer-specific mortality in localized prostate cancer patients.
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Bagshaw H, Ruth K, Horwitz EM, Chen DYT, Buyyounouski MK. Does family history of prostate cancer affect outcomes following radiotherapy? Radiother Oncol 2014; 110:229-34. [PMID: 24560758 DOI: 10.1016/j.radonc.2013.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 11/11/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine family history (FH) as a prognostic factor following radiotherapy (RT). MATERIALS AND METHODS Between 1989 and 2007, 1711 men with clinically localized prostate cancer and complete family history who had received RT (median RT dose=74Gy) without androgen deprivation therapy were analyzed. FH was defined as any prostate cancer in a first degree relative. For the biochemical failure (BF) outcome, this sample size has 85% power to detect a hazard ratio of 1.56 for positive versus negative FH. RESULTS With a median follow-up of 71 months, there was no significant difference in the distribution of Gleason score (GS) or prostate specific antigen (PSA) based on FH. A positive FH was not an independent predictor of BF, distant metastasis (DM), prostate cancer specific mortality (PCSM), or overall mortality (OM) in Cox proportional multivariable analysis. On further analysis in a Cox proportional multivariable analysis, men with two or more first degree relatives with prostate cancer had a significantly higher likelihood of BF and DM than those with no FH, although there was no difference in PCSM or OM. Men with a positive FH (23%) were more likely to be younger, have a lower PSA, and non-palpable disease. There was no interaction between a positive FH and neither race nor treatment era (pre-PSA vs. PSA era). CONCLUSIONS A positive FH is not a prognostic factor following RT and should not alter standard treatment recommendations. Patients with two or more first degree relatives with prostate cancer had a higher likelihood of BF and DM, but there was no effect on survival. There was no interaction between a positive FH and African American race or treatment era. A positive FH was however, associated with more favorable PSA values and T-stage that may be the result of earlier screening.
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Affiliation(s)
- Hilary Bagshaw
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, United States
| | - Karen Ruth
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, United States
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, United States
| | - David Y T Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, United States
| | - Mark K Buyyounouski
- Department of Radiation Oncology, Stanford University, Stanford, United States.
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Peters CA, Stock RG, Blacksburg SR, Stone NN. Effect of Family History on Outcomes in Patients Treated With Definitive Brachytherapy for Clinically Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2009; 73:24-9. [DOI: 10.1016/j.ijrobp.2008.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 04/01/2008] [Accepted: 04/07/2008] [Indexed: 10/21/2022]
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Roehl KA, Loeb S, Antenor JAV, Corbin N, Catalona WJ. Characteristics of patients with familial versus sporadic prostate cancer. J Urol 2006; 176:2438-42; discussion 2442. [PMID: 17085123 DOI: 10.1016/j.juro.2006.07.159] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE There are conflicting reports concerning whether prostate cancer in families with multiple affected members has different clinical and pathological features than sporadic cases. In our study we compared the clinical characteristics, pathological outcomes and the 7-year biochemical progression-free rate in patients with apparent sporadic prostate cancer, affected sibling pairs, families with multiple affected members and families meeting the Johns Hopkins criteria for hereditary prostate cancer. MATERIALS AND METHODS From 1983 to 2003, 3,478 men underwent radical retropubic prostatectomy by a single surgeon (WJC). Of these men 1,186 reported family history status. We compared age at surgery, prostate specific antigen at diagnosis, pathological tumor stage, Gleason score, tumor characteristics and 7-year biochemical progression-free survival rates in the groups using chi-square, 1-way ANOVA or Cox proportional hazards regression analysis. RESULTS The 7-year biochemical progression-free survival rates were 81% for sporadic cases, 71% for sibling pairs, 72% for hereditary cases and 81% for high density family members (p = 0.3). Of the clinical and pathological features examined only age (p <0.0001) and positive surgical margin rate (p = 0.03) were significantly different among groups. CONCLUSIONS In our study population clinicopathological features and progression-free survival are similar between sporadic and familial prostate cancer cases. The sibling pairs had a trend toward less favorable tumor features and progression-free survival, but the difference was not statistically significant.
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Affiliation(s)
- Kimberly A Roehl
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Kupelian PA, Reddy CA, Reuther AM, Mahadevan A, Ciezki JP, Klein EA. Aggressiveness of familial prostate cancer. J Clin Oncol 2006; 24:3445-50. [PMID: 16849760 DOI: 10.1200/jco.2006.05.7661] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To report on the aggressiveness of sporadic versus familial prostate cancer. PATIENTS AND METHODS The study sample consisted of 4,112 stage T1-3 prostate cancer patients. The outcome of interest was biochemical relapse-free survival (bRFS). The analysis was performed for two distinct time periods, 1986 to 1992 (year < or = 1992) and 1993 to 2002 (year > or = 1993), to encompass both the early and late prostate-specific antigen (PSA) eras. RESULTS A positive family history (FH positive) was reported in 16%. The 10-year bRFS rates for patients with negative family history (FH negative) versus FH positive were 59% and 63%, respectively (P = .90). However, in the year < or = 1992 period, the 10-year bRFS rates for FH negative versus FH positive were 45% and 34%, respectively (P = .015). In the year > or = 1993 period, the 10-year bRFS rates for FH negative versus FH positive were 61% and 67%, respectively (P = .54). Multivariate analysis failed to reveal family history as an independent predictor of relapse (P = .42). However, in the subset of patients in each era, family history was an independent predictor of relapse only for those treated in the year < or = 1992 period (P = .038). CONCLUSION Family history was an independent predictor of biochemical failure only early in the PSA era, and men with an FH positive presented with more favorable disease later in the PSA era. This suggests that with stage migration and improved therapy, the impact of family history on prognosis has become minimal. However, underlying genetic factors affecting prostate cancer behavior in individuals with familial prostate cancer may still be important in determining individual prognosis.
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Affiliation(s)
- Patrick A Kupelian
- Glickman Urological Institute and Radiation Oncology Department, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Roemeling S, Roobol MJ, de Vries SH, Gosselaar C, van der Kwast TH, Schröder FH. Prevalence, treatment modalities and prognosis of familial prostate cancer in a screened population. J Urol 2006; 175:1332-6. [PMID: 16515992 DOI: 10.1016/s0022-5347(05)00698-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE A family history of prostate cancer is an important risk factor for this disease. The clinical presentation and prognosis of familial disease remain uncertain. In this study these entities are evaluated in the first and second rounds of a screening program in The Netherlands. MATERIALS AND METHODS Of all men randomized in the Rotterdam section of the ERSPC, 19,970 men were eligible for screening. Information regarding the family history was obtained by a self-administered questionnaire at baseline. RESULTS In the prevalence screen the cancer detection rate in 1,364 men (7.1%) with a positive family history was 7.7% (106 cancers in 1,364 screened men with a positive family history) while the positive predictive value of the biopsies was 32.2% (154 cancers of 532 biopsies). In 12,803 sporadic cases the detection rate was 4.7% and the positive predictive value was 23.6% (p <0.0001 and 0.003, RR 1.63). No clinicopathological differences were found in the 1,559 men diagnosed in the first and second rounds. The overall biochemical-free survival rate after a mean followup of 56.8 months (range 0 to 129.9) was 76.8%, and was not significantly different in familial and sporadic cases (p = 0.840). These findings were consistent for the specific treatment modalities as well. CONCLUSIONS Although screened men 55 to 75 years old with a father or a brother having prostate cancer themselves are at a substantially greater risk for the disease, the clinical presentation, treatment modalities and prognosis by biochemical progression are not different compared to sporadic cases.
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Affiliation(s)
- Stijn Roemeling
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Abstract
Although prostate cancer tends to be a slow-growing neoplasm affecting older men, there is clearly a subset of patients at high risk for developing early and possibly more aggressive disease. This group of high-risk patients includes men with a family history of prostate cancer and various histologic features such as PIN and ASAP identified on an initial biopsy. Black American men have a much higher risk of developing prostate cancer when compared with white men and especially Asian men. This finding may reflect both genetic and environmental factors. Screening men at increased risk of developing prostate cancer appears to be a logical strategy, especially in light of recent reports that suggest a benefit to aggressive treatment.
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Affiliation(s)
- Kisseng Hsieh
- Division of Urology, Department of Surgery, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3955, USA
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Ray ME, Dunn RL, Cooney KA, Sandler HM. Family history of prostate cancer and relapse after definitive external beam radiation therapy. Int J Radiat Oncol Biol Phys 2003; 57:371-6. [PMID: 12957247 DOI: 10.1016/s0360-3016(03)00504-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The influence of family history on outcome after definitive therapy for prostate cancer has been disputed. One series reported increased relapse rates in men with a positive family history of prostate cancer treated with radical prostatectomy or radiation therapy, whereas others have reported no difference in outcome. We examined our series of patients treated with definitive external beam radiation therapy to determine if a positive family history for prostate cancer is associated with better or worse outcome. METHODS AND MATERIALS Family history information was available for 538 patients treated with radiation therapy for prostate cancer between 1983 and 2001. Prostate cancer in one or more first-degree relatives (father, brother, or son) was considered a positive family history. The endpoint of interest was time to prostate-specific antigen failure or initiation of hormonal therapy after radiation therapy. RESULTS Ninety-seven of 538 patients (18%) had a positive family history. There were no significant differences between the positive and negative family history groups. Family history had no effect on relapse-free survival rates in the entire cohort (p = 0.94) or in any subgroup. African American patients with a positive family history had significantly worse 5-year relapse-free survival rates, although there were few patients in this subgroup. Neither family history nor race was a statistically significant predictor of relapse in multivariate analysis; however, combined African American race and positive family history was associated with worse relapse-free survival rates. CONCLUSIONS In this large study of patients receiving definitive radiation therapy for localized prostate cancer, no relationship was found between positive first-degree family history of prostate cancer and relapse. The influence of family history on clinical outcome may be more understandable once the gene or genes responsible for hereditary prostate cancer are identified.
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Affiliation(s)
- Michael E Ray
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, USA.
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Abstract
OBJECTIVE To identify published studies quantifying familial prostate cancer risks in relatives of prostate cancer cases and, by meta-analysis, obtain more precise estimates of familial risk according to the family history. METHODS Thirteen case-control and cohort studies were identified which have reported risks of prostate cancer in relatives of prostate cancer cases. Pooled estimates of risk for various categories of family history were obtained by calculating the weighted average of the log relative risk (RR) estimates from studies. RESULTS The pooled RR (95% confidence interval) in first-degree relatives was 2.5 (2.2-2.8). There was evidence that this was highest in relatives of cases diagnosed before age 60 years and that RRs declined with age. The risk for the few men with two affected relatives was increased 3.5-fold (2.6-4.8). RRs to sons of cases appeared to be lower than in brothers; a complete explanation of this observation is uncertain. CONCLUSION Men with a family history of prostate cancer have a significantly greater risk of developing prostate cancer than those with no such history. Risks are greatest for relatives of cases diagnosed when young and those with more than one relative affected.
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Affiliation(s)
- L E Johns
- Section of Cancer Genetics, Institute of Cancer Research, Sutton, Surrey, UK
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Abstract
Major risk factors for developing prostate cancer, including positive family history and African-American ethnicity, can be quantified for genetic counseling. Factors increasing familial risk for prostate cancer are closer degree of kinship, number of affected relatives, and early age of onset (< 50 years) among the affected relatives. Genetic testing may be useful for modification of risk, but currently should be performed only within the context of a well-designed research study that will determine penetrance and genotype-phenotype correlation of specific mutations. Even in the absence of genetic testing, African-American men and men with a strong family history of prostate cancer may opt to initiate screening by prostate specific antigen (PSA) and digital rectal exam (DRE) screening at age 40.
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Affiliation(s)
- A M Nieder
- Department of Urology and NYU Cancer Institute, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
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McMullen KP, Lee WR. A structured literature review to determine the use of the American Society for Therapeutic Radiology and Oncology consensus definition of biochemical failure. Urology 2003; 61:391-6. [PMID: 12597954 DOI: 10.1016/s0090-4295(02)02259-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The American Society for Therapeutic Radiology and Oncology consensus definition (ACD) of biochemical failure after radiotherapy for prostate cancer requires three consecutive prostate-specific antigen increases from a nadir value. The members of the Consensus Panel recognized that the timing and frequency of prostate-specific antigen determinations could affect the comparability among different reports if this definition was used. For this reason, the Consensus Panel members recommended three guidelines for studies presented for publication (publication guidelines [PGs]). The present analysis examined the extent to which the ACD has been used in the peer-reviewed published literature and how frequently the PGs have been followed. METHODS A structured literature review of 10 relevant journals was done. The inclusion criteria for the literature review required publication in calendar year 1999 or 2000; treatment with external beam radiotherapy and/or brachytherapy for previously untreated, nonmetastatic prostate cancer; and the use of a prostate-specific antigen-defined disease-free endpoint. A standardized checklist was created and completed by both of the authors. We independently reviewed each publication to determine whether the ACD of biochemical failure was used and whether the PGs were followed. Discrepancies between us were resolved by joint review of each publication in question to achieve a consensus. RESULTS Fifty-seven articles met the inclusion criteria. The median number of patients in the articles reviewed was 302 (range 22 to 2222). The ACD was followed in 37 (64.9%) of 57 articles. None of the reviewed articles followed all three PGs. In five articles (8.7%), two of the three PGs were followed. The vast majority of the articles reviewed (52 of 57, 91.3%) followed one or none of the PGs recommended by the Consensus Panel. CONCLUSIONS The ACD was used in two thirds of peer-reviewed published articles. The PGs were followed much less frequently. Consistent standards of reporting have not been uniformly applied to peer-reviewed manuscripts.
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Affiliation(s)
- Kevin P McMullen
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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Abstract
PURPOSE We review the current epidemiological and genetic knowledge regarding hereditary prostate cancer, and outline its clinical implications. MATERIALS AND METHODS Published articles on hereditary prostate cancer were identified using the MEDLINE data base. RESULTS A risk of prostate cancer, particularly early onset disease, is strongly affected by family history (number of relatives with prostate cancer and their age at diagnosis). A family history of prostate cancer increases the positive predictive value of prostate specific antigen testing and, hence, heredity should always be assessed when deciding whether to perform biopsies in a man with a prostate specific antigen level of 3 to 10 ng./ml. Epidemiological studies indicate that dominantly inherited susceptibility genes with high penetrance cause 5% to 10% of all prostate cancer cases, and as much as 30% to 40% of early onset disease. More than a half dozen chromosome loci that may comprise such genes have been mapped, but as of May 2002 no prostate cancer susceptibility gene of major importance had been cloned. Most likely, environmental factors and comparatively common variants of several other genes affect prostate cancer risk in families with or without multiple cases of the disease. On average, hereditary prostate cancer is diagnosed 6 to 7 years earlier than sporadic prostate cancer, but does not otherwise differ clinically from the sporadic form. As a consequence of the earlier onset, a greater proportion of men with hereditary prostate cancer die of the disease than those with nonhereditary prostate cancer. At present, the only clinically applicable measure to reduce prostate cancer mortality in families with hereditary disease is screening, with the aim of diagnosing the disease when it is still in a curable stage. CONCLUSIONS Hereditary susceptibility is now considered the strongest risk factor for prostate cancer and has profound clinical importance. The genetic mechanism behind such susceptibility has turned out to be more complex than initially thought, and will probably not be completely understood for many years to come.
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Affiliation(s)
- Ola Bratt
- Unit for Urology, Helsingborg Hospital, Sweden
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Hereditary Prostate Cancer: Clinical Characteristics and Survival. J Urol 2002. [DOI: 10.1097/00005392-200206000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- O Bratt
- Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
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