title: Family history and prostate cancer screening with prostate-specific antigen.
abstract: OBJECTIVE
  Early detection of prostate cancer has been recommended for men with affected first-degree relatives despite the lack of evidence for mortality reduction. We therefore evaluated the impact of family history in the Finnish prostate cancer screening trial.
  
  
  METHODS
  Approximately 80,000 men were identified from the population register for the first screening round. Of the 32,000 men randomized to the screening arm, 30,403 were eligible at the time of invitation. A blood sample was drawn from the participants (n = 20,716), and serum prostate-specific antigen (PSA) was determined. Men with a PSA level > or = 4.0 ng/mL were referred for prostate biopsy. Information on family history was obtained through a self-administered questionnaire at baseline.
  
  
  RESULTS
  A total of 964 (5%) of the 20,716 screening participants had a positive family history, and 105 (11%) were screening-positive. Twenty-nine tumors were diagnosed, corresponding to a detection rate of 3.0% (29 of 964) and a positive predictive value of 28% (29 of 105). Of the 19,347 men without a family history, 1,487 (8%) had a PSA level > or = 4.0 ng/mL. The detection rate was 2.4% (462 of 19,347) and the positive predictive value was 31% (462 of 1,487). The risk associated with a positive family history was not substantially increased (rate ratio, 1.3; 95% confidence interval, 0.9 to 1.8). The results were not affected by the age of the screenee or age at diagnosis of the affected relative. The program sensitivity was 6% (29 of 491) (ie, selective screening policy would have missed 94% of cancers in the population). No differences were seen in the characteristics of screen-detected cancers by family history.
  
  
  CONCLUSIONS
  Our findings provide no support for selective screening among men with affected relatives.
authors.affiliation: Finnish Cancer Registry, Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki. tuuka.makinen@cancer.fi
authors.forename: Tuukka
authors.initials: T
authors.lastname: Mäkinen
authors.forename: Teuvo L J
authors.initials: TL
authors.lastname: Tammela
authors.forename: Ulf-Håkan
authors.initials: UH
authors.lastname: Stenman
authors.forename: Liisa
authors.initials: L
authors.lastname: Määttänen
authors.forename: Sakari
authors.initials: S
authors.lastname: Rannikko
authors.forename: Jussi
authors.initials: J
authors.lastname: Aro
authors.forename: Harri
authors.initials: H
authors.lastname: Juusela
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005387:Finland / Q000453:epidemiology; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000517:prevention & control*; D012306:Risk; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D017430:Prostate-Specific Antigen