Clinical characteristics of African-American men with hereditary prostate cancer: the AAHPC Study.
BACKGROUND
The African-American Hereditary Prostate Cancer (AAHPC) Study was designed to recruit African-American families fulfilling very stringent criteria of four or more members diagnosed with prostate cancer at a combined age at diagnosis of 65 years or less. This report describes the clinical characteristics of a sample of affected AAHPC family members.


METHODS
In all, 92 African-American families were recruited into the study between 1998 and 2002. Complete clinical data including age and PSA at diagnosis, number of affected per family, stage, grade, and primary treatment were available on 154 affected males. Nonparametric Wilcoxon two-sample tests and Fisher's exact test (two-tailed), were performed to compare families with 4-6 and >6 affected males with respect to clinical characteristics.


RESULTS
The mean number of affected men per family was 5.5, with a mean age at diagnosis of 61.0 (+/-8.4) years. Age at diagnosis, PSA and Gleason score did not show significant differences between the two groups of families. Based on the Gleason score, 77.2% of affected males had favorable histology. Significantly, there were marked differences between the two groups in the frequency of node-positive disease (P=0.01) and distant metastases (P=0.0001). Radical prostatectomy was the preferred primary therapy for 66.2% of all affected men followed by 20.8% who chose radiation therapy.


CONCLUSIONS
Our findings suggest that affected males who carry the highest load of genetic factors are at the highest risk for early dissemination of disease, thus efforts at early diagnosis and aggressive therapeutic approaches may be warranted in these families. Since the primary therapy choices in our study favored definitive treatment (87.0%) when compared to the 1983 and 1995 SEER data in which 28 and 64% received definitive treatment, respectively, it appears that affected African-American men in multiplex families may be demonstrating the reported psycho-social impact of family history on screening practices and treatment decisions for prostate cancer.
Ahaghotu
C
C
National Human Genome Center, Howard University, Washington, DC, USA. cahaghotu@howard.edu
Baffoe-Bonnie
A
A
Kittles
R
R
Pettaway
C
C
Powell
I
I
Royal
C
C
Wang
H
H
Vijayakumar
S
S
Bennett
J
J
Hoke
G
G
Mason
T
T
Bailey-Wilson
J
J
Boykin
W
W
Berg
K
K
Carpten
J
J
Weinrich
S
S
Trent
J
J
Dunston
G
G
Collins
F
F
D001741:Black or African American; D017668:Age of Onset; D000368:Aged; D015331:Cohort Studies; D003657:Decision Making; D005192:Family Health; D020022:Genetic Predisposition to Disease; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D011379:Prognosis; D017430:Prostate-Specific Antigen; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000601:surgery
D017430:Prostate-Specific Antigen