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Aggressiveness of Familial Prostate Cancer

Patrick A. Kupelian, Chandana A. Reddy, Alwyn M. Reuther, Arul Mahadevan, Jay P. Ciezki, Eric A. Klein

From the Glickman Urological Institute and Radiation Oncology Department, Cleveland Clinic Foundation, Cleveland, OH; and the Radiation Oncology Department, M.D. Anderson Cancer Center Orlando, Orlando, FL

Address reprint requests to Patrick A. Kupelian, MD, Department of Radiation Oncology, M.D. Anderson Cancer Center Orlando, 1400 S Orange Avenue, Orlando, FL 32806; e-mail: patrick.kupelian{at}orhs.org

PURPOSE: To report on the aggressiveness of sporadic versus familial prostate cancer.

PATIENTS AND METHODS: The study sample consisted of 4,112 stage T1-3 prostate cancer patients. The outcome of interest was biochemical relapse-free survival (bRFS). The analysis was performed for two distinct time periods, 1986 to 1992 (year 1992) and 1993 to 2002 (year 1993), to encompass both the early and late prostate-specific antigen (PSA) eras.

RESULTS: A positive family history (FH positive) was reported in 16%. The 10-year bRFS rates for patients with negative family history (FH negative) versus FH positive were 59% and 63%, respectively (P = .90). However, in the year 1992 period, the 10-year bRFS rates for FH negative versus FH positive were 45% and 34%, respectively (P = .015). In the year 1993 period, the 10-year bRFS rates for FH negative versus FH positive were 61% and 67%, respectively (P = .54). Multivariate analysis failed to reveal family history as an independent predictor of relapse (P = .42). However, in the subset of patients in each era, family history was an independent predictor of relapse only for those treated in the year 1992 period (P = .038).

CONCLUSION: Family history was an independent predictor of biochemical failure only early in the PSA era, and men with an FH positive presented with more favorable disease later in the PSA era. This suggests that with stage migration and improved therapy, the impact of family history on prognosis has become minimal. However, underlying genetic factors affecting prostate cancer behavior in individuals with familial prostate cancer may still be important in determining individual prognosis.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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