title: Prostate cancer risk with positive family history, normal prostate examination findings, and PSA less than 4.0 ng/mL.
abstract: OBJECTIVE
  Family history has been identified as a risk factor for prostate cancer. We assessed the risk of prostate cancer in men with a positive family history (at least one first-degree or second-degree relative), normal digital rectal examination (DRE) and a serum prostate-specific antigen (PSA) level of 4.0 ng/mL.
  
  
  METHODS
  A total of 87 volunteers from the San Antonio Center of biomarkers of risk for prostate cancer study enrolled in a prospective study to assess the prevalence of prostate cancer in men with a family history of prostate cancer, normal DRE findings, and a serum PSA level of 4.0 ng/mL or less. All subjects underwent transrectal ultrasound-guided prostate biopsy.
  
  
  RESULTS
  Prostate cancer was diagnosed in 22 (25.3%) of the 87 participants. The PSA values were significantly greater statistically in the men with prostate cancer (median 2.1 ng/mL) than in the men without prostate cancer (median 1.2 ng/mL, P = 0.01), and the odds of prostate cancer nearly doubled for a doubling of the PSA level within this interval (odds ratio 1.97, P = 0.02). No statistically significant difference was found in age, race, or number and type of affected relatives in men with and without prostate cancer.
  
  
  CONCLUSIONS
  The results of our study have demonstrated a high frequency of prostate cancer in men with a positive family history but normal DRE findings and a PSA level of 4.0 ng/mL or less. These prospectively collected data raise an important consideration regarding lowering the PSA cutoff values for offering biopsy in patients with a positive family history and normal DRE findings.
authors.affiliation: Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
authors.forename: Edith
authors.initials: E
authors.lastname: Canby-Hagino
authors.forename: Javier
authors.initials: J
authors.lastname: Hernandez
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Brand
authors.forename: Dean A
authors.initials: DA
authors.lastname: Troyer
authors.forename: Betsy
authors.initials: B
authors.lastname: Higgins
authors.forename: Donna Pauler
authors.initials: DP
authors.lastname: Ankerst
authors.forename: Ian M
authors.initials: IM
authors.lastname: Thompson
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Leach
authors.forename: Dipen J
authors.initials: DJ
authors.lastname: Parekh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D051517:Digital Rectal Examination; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000235:genetics*; D018084:Ultrasonography, Interventional
chemical_list: D017430:Prostate-Specific Antigen