A positive family history as risk factor for prostate cancer in a population-based study with organized PSA-screening: results of the Swiss ERSPC (Aarau)

OBJECTIVE: To assess the value of positive family history (FH) as a risk factor for prostate cancer (PCa) incidence and grade among men undergoing organized PSA-screening in a populationbased study. PATIENTS AND METHODS: The study cohort comprised all attendees of the Swiss arm of the ERSPC with systematic PSA-tests every 4 years. Men reporting first-degree relative(s) diagnosed with PCa were considered to have a positive FH. Biopsy was exclusively PSA-triggered with a threshold of 3ng/ml. Primary endpoint was PCa diagnosis. Kaplan-Meier and Cox regression analyses were used. RESULTS: Of 4,932 attendees with a median age of 60.9 (IQR 57.6-65.1) years, 334 (6.8%) reported a positive FH. Median follow-up duration was 11.6 years (IQR 10.3-13.3). Cumulative PCa incidence was 60/334 (18%, positive FH) and 550/4,598 (12%, negative FH) (OR 1.6, 95%CI 1.2-2.2, p=0.001), respectively. In both groups, most PCa diagnosed had a low grade. There were no significant differences of PSA at diagnosis, biopsy Gleason score or Gleason score on pathologic specimen among men who underwent radical prostatectomy between both groups, respectively. On multivariable analysis, age (HR 1.04, 95% CI 1.02-1.06), baseline PSA (HR 1.13 95% CI 1.12-1.14), and FH (HR 1.6, CI 1.242.14) were independent predictors for overall PCa incidence (p<0.0001 each). Only baseline PSA (HR 1.14, 95%CI 1.12-1.16, p<0.0001) was an independent predictor of Gleason score 7 PCa on prostate biopsy. The proportion of interval PCa diagnosed in between the screening rounds was non-significantly different. CONCLUSION: Irrespective of the FH status, the current PSA-based screening setting detects the majority of aggressive PCa 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 for low grade but not aggressive PCa. This article is protected by copyright. All rights reserved. DOI: https://doi.org/10.1111/bju.13310 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-113195 Journal Article Accepted Version Originally published at: Randazzo, Marco; Müller, Alexander; Carlsson, Sigrid; Eberli, Daniel; Huber, Andreas; Grobholz, Rainer; Manka, Lukas; Mortezavi, Ashkan; Sulser, Tullio; Recker, Franz; Kwiatkowski, Maciej (2016). A positive family history as risk factor for prostate cancer in a population-based study with organized PSA-screening: results of the Swiss ERSPC (Aarau). BJU International, 117(4):576-583. DOI: https://doi.org/10.1111/bju.13310 Title A Positive Family History as risk factor for Prostate Cancer in a Population-based Study with organized PSA-Screening: Results of the Swiss ERSPC (Aarau) Marco Randazzo, Alexander Müller, Sigrid Carlsson, Daniel Eberli , Andreas Huber, Rainer Grobholz, Lukas Manka, Ashkan Mortezavi, Tullio Sulser, Franz Recker and Maciej Kwiatkowski 1 Department of Urology, University Hospital Zürich, Switzerland Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, NY, USA 3 Department of Urology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden 4 Department of Laboratory Medicine, Cantonal Hospital Aarau, Switzerland 5 Department of Pathology, Cantonal Hospital Aarau, Switzerland 6 Department of Urology, Academic Hospital Braunschweig, Germany 7 Department of Urology, Cantonal Hospital Aarau, Switzerland Corresponding Author: Marco Randazzo, MD University Hospital Zürich Department of Urology CH-8091 Zürich, Switzerland E-mail: marco_randazzo1@hotmail.com