Familial risk for prostate cancer: genetics vs. disease-seeking activity

A study published yesterday in the Journal of the National Cancer Institute raises interesting questions about prostate cancer risk and family history of the disease.

Bratt et al. have used data from the Swedish national, population-based Prostate Cancer Database Sweden (PCBaSe Sweden) to explore the relationship between the risk for prostate cancer among 22,511 brothers of 13,975 index patients using so-called “standardized incidence ratios” (SIRs).

The results of their study showed that:

  • Brothers of index patients with prostate cancer were at increased risk for a diagnosis of prostate cancer (SIR = 3.1).
  • Risk was higher for T1c tumors (SIR = 3.4) than for metastatic tumors (SIR = 2.0).
  • Risk of T1c tumors was especially high
    • During the first year after the diagnosis of the index patient (SIR = 4.3) compared with the following years (SIR range = 2.8–3.3).
    • For brothers of index patients who had a higher socioeconomic status (SIR = 4.2) compared with brothers of index patients with lower socioeconomic status (SIR = 2.8).

The authors conclude that men with a family history of prostate cancer seem to have a higher probability of diagnostic activity, which then appears to contribute to their increased risk of prostate cancer and also to detection bias in epidemiological and genetic studies of familial prostate cancer.

In an interesting editorial commentary in the same issue of the journal, Thompson et al. discuss this article and the complexities of using PSA testing to assess risk for prostate cancer today. They conclude with the interesting statement that:

Perhaps the best tactic would be to change our approach from seeking risk factors for prostate cancer (a disease that is ubiquitous, with many patients probably being better off if it were not detected by screening) to an assessment of factors related to biologically consequential prostate cancer (i.e., metastatic disease or prostate cancer-specific death).

Additional information about this study can be found in an article on the HealthDay web site.

One Response

  1. It is well-known fact that men with a family of prostate cancer are at higher risk than others. The “study” reconfirms that fact. I wonder when will people stop spending money on studies that don’t bring any new information.

    And of course, we cannot evade the ever-popular topic of PSA screening. It is so very typical of the “New” Prostate Cancer InfoLink and so demonstrative of its position to highlight the quote on screening. Frankly speaking, I don’t quite understand this misguided position. In the absence of a better test, we should use PSA to screen people. Do the authors recommend that the screening should be based on family history only? Is there a better way than PSA testing to detect prostate cancer and to determine whether it is metastatic or local?

    It seems to me that instead of having a debate based on scientific facts, this discussion becomes a “religious war.”

    It is disturbing when people who should know better continue to put forward the phony argument of “over diagnosis” instead of focusing on potential “over-treatment” or ‘misdiagnosis’. It is indicative of the fact that opponents to PSA screening do not have the facts to support them when they continue to claim they are not against testing, but only against screening. The problem is not with men educated on the topic of prostate cancer who DEMAND to be tested. The problem is with the numerous men who don’t know [to ask] their primary care physician for a PSA test.

    Proposing a “discussion with your doctor” is a decoy. It all depends on how things are presented. If I am in favor: “You should have a PSA test. If you have prostate cancer it will detect it at an early stage and it may be curable. There are some possible side effects, but if we act early, the chance are slim.” I am against: “There are people who would recommend you have a PSA test. Be advised that the results are ambiguous and may lead to psychological stress that will make you undertake unneeded treatment that, in many cases, results in side effects impacting your quality of life, such as impotence or incontinence.”

    The whole campaign in favor of PSA screening should highlight the potential benefits of catching prostate cancer early. They should emphasize the fact that prostate cancer detection and intervention is most beneficial for men between 45 and 60 who are in good health and who will greatly benefit from reduced prostate cancer-related mortality.

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