title: Detection of subclinical cancers by prostate-specific antigen screening in asymptomatic men from high-risk prostate cancer families.
abstract: Positive family history is a significant risk factor for prostate cancer. Improved knowledge of the epidemiology and molecular basis of hereditary prostate cancer has led to a need for counseling and clinical follow-up for men with a positive family history of prostate cancer. However, very little information is available on the efficacy of early screening procedures, such as serum prostate-specific antigen (PSA) measurements, in the management of genetically predisposed, high-risk individuals. In a nationwide study, we obtained family histories from 2099 Finnish prostate cancer patients and identified 302 families with two or more affected cases. Here, 209 asymptomatic 45-75-year-old males from these families were included in a study to determine the frequency of serum PSA positivity and the prevalence of subclinical prostate cancers. Serum PSA was elevated in 21 (10.0%) of these high-risk individuals. Seven prostate cancers (3.3%) and two high-grade prostatic intraepithelial neoplasia lesions were diagnosed, with three cancers occurring in men ages < or = 59 years. Men from prostate cancer families with an average age of onset of < 60 years had a significantly higher frequency of PSA positivity (28.6%, P = 0.01) as well as cancers (14.3%, P = 0.02) than those with a later age of onset. The results suggest that prostate cancer development in genetically predisposed individuals is preceded by a subclinical period when PSA detection is possible. Serum PSA screening may be particularly useful in men with a family history of early-onset prostate cancer.
authors.affiliation: Laboratory of Cancer Genetics, Institute of Medical Technology, University of Tampere and Tampere University Hospital, Finland. memima@uta.fi
authors.forename: M P
authors.initials: MP
authors.lastname: Matikainen
authors.forename: J
authors.initials: J
authors.lastname: Schleutker
authors.forename: P
authors.initials: P
authors.lastname: Mörsky
authors.forename: O P
authors.initials: OP
authors.lastname: Kallioniemi
authors.forename: T L
authors.initials: TL
authors.lastname: Tammela
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D017668:Age of Onset; D000368:Aged; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D011237:Predictive Value of Tests; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D012680:Sensitivity and Specificity
chemical_list: D017430:Prostate-Specific Antigen