Targeted screening for prostate cancer in high risk families: early onset is a significant risk factor for disease in first degree relatives.
OBJECTIVE
Targeted screening for prostate cancer in high risk families is generally suggested by ages 40 to 45 years in first degree relatives. We support this concept by reporting higher risk and earlier onset of the disease in these families.


METHODS
We proposed serum prostate specific antigen (PSA) testing in 40 to 70-year-old first degree relatives of 435 patients with prostate cancer treated between July 1994 and June 1997. A previous systematic genealogical analysis allowed us to define the familial prostate cancer status of each patient as sporadic or familial.


RESULTS
Of the 747 potential candidates 442 (59%) accepted into the study have been screened, including 240 who were 40 to 49 years old (mean age 44.8) and 202 who were 50 to 70 years old (mean age 57.4). Two of the 240 subjects (0.8%) had PSA greater than 4 ng./ml. in the 40 to 49-year-old group. Prostate biopsies were negative in 1 relative but diagnostic for prostate cancer in the other. In the 50 to 70-year-old group 25 of 202 subjects (12.4%) had a PSA of greater than 4 ng./ml. Prostate cancer was diagnosed in 9 individuals (4.5%), 9 had negative biopsy results, 1 died before biopsy and 6 refused biopsy. The proportion of relatives with PSA greater than 4 ng./ml. and prostate cancer detection was not different according to familial status (sporadic or familial) but it was significantly higher in first degree relatives with early onset prostate cancer in the family at ages younger than 65 years (p = 0.037 and 0.012, respectively).


CONCLUSIONS
Our results emphasize the usefulness of PSA screening in high risk families, including those without obvious hereditary features. Furthermore, early onset prostate cancer is a significant risk factor for prostate cancer in first degree relatives.
Service d'Urologie, Centre Hospitalier Universitaire, Brest Cedex, France.
Antoine
A
Valeri
Luc
L
Cormier
Marie-Pierre
MP
Moineau
Geraldine
G
Cancel-Tassin
Rahmene
R
Azzouzi
Laurent
L
Doucet
Francoise
F
Baschet
Isabelle
I
Cussenot
Joel
J
L'Her
Philippe
P
Berthon
Philippe
P
Mangin
Olivier
O
Cussenot
Jean-Francois
JF
Morin
Geroges
G
Fournier
D000328:Adult; D000368:Aged; D020132:Anticipation, Genetic; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010375:Pedigree; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D012307:Risk Factors
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen