A positive family history as a risk factor for prostate cancer in a population-based study with organised prostate-specific antigen screening: results of the Swiss European Randomised Study of Screening for Prostate Cancer (ERSPC, Aarau).
OBJECTIVE
To assess the value of a positive family history (FH) as a risk factor for prostate cancer incidence and grade among men undergoing organised prostate-specific antigen (PSA) screening in a population-based study.


METHODS
The study cohort comprised all attendees of the Swiss arm of the European Randomised Study of Screening for Prostate Cancer (ERSPC) with systematic PSA level tests every 4 years. Men reporting first-degree relative(s) diagnosed with prostate cancer were considered to have a positive FH. Biopsy was exclusively PSA triggered at a PSA level threshold of 3 ng/mL. The primary endpoint was prostate cancer diagnosis. Kaplan-Meier and Cox regression analyses were used.


RESULTS
Of 4 932 attendees with a median (interquartile range, IQR) age of 60.9 (57.6-65.1) years, 334 (6.8%) reported a positive FH. The median (IQR) follow-up duration was 11.6 (10.3-13.3) years. Cumulative prostate cancer incidence was 60/334 (18%, positive FH) and 550/4 598 (12%, negative FH) [odds ratio 1.6, 95% confidence interval (CI) 1.2-2.2, P = 0.001). In both groups, most prostate cancer diagnosed was low grade. There were no significant differences in PSA level at diagnosis, biopsy Gleason score or Gleason score on pathological specimen among men who underwent radical prostatectomy between both groups. On multivariable analysis, age (hazard ratio [HR] 1.04, 95% CI 1.02-1.06), baseline PSA level (HR 1.13, 95% CI 1.12-1.14), and FH (HR 1.6, 95% CI 1.24-2.14) were independent predictors for overall prostate cancer incidence (all P < 0.001). Only baseline PSA level (HR 1.14, 95% CI 1.12-1.16, P < 0.001) was an independent predictor of Gleason score ≥7 prostate cancer on prostate biopsy. The proportion of interval prostate cancer diagnosed in-between the screening rounds was not significantly different.


CONCLUSIONS
Irrespective of the FH status, the current PSA-based screening setting detects the majority of aggressive prostate cancers and missed only a minority of interval cancers with a 4-year screening algorithm. Our results suggest that men with a positive FH are at increased risk of low-grade but not aggressive prostate cancer.
Department of Urology, University Hospital Zürich, Zürich, Switzerland.|Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.
Marco
M
Randazzo
Department of Urology, University Hospital Zürich, Zürich, Switzerland.
Alexander
A
Müller
Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Sigrid
S
Carlsson
Department of Urology, University Hospital Zürich, Zürich, Switzerland.
Daniel
D
Eberli
Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
Andreas
A
Huber
Department of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland.
Rainer
R
Grobholz
Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
Lukas
L
Manka
Department of Urology, University Hospital Zürich, Zürich, Switzerland.
Ashkan
A
Mortezavi
Department of Urology, University Hospital Zürich, Zürich, Switzerland.
Tullio
T
Sulser
Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.
Franz
F
Recker
Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.|Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
Maciej
M
Kwiatkowski
D000368:Aged; D055088:Early Detection of Cancer; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010375:Pedigree; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000378:metabolism*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000517:prevention & control; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology
D017430:Prostate-Specific Antigen
positive family history; prostate cancer aggressiveness; prostate cancer screening; prostate-specific antigen; screening intensity