Login to Access Video or Poster Abstract: MP33-04
Sources of Funding: Programme Hospitalier de Recherche Clinique, Ligue Nationale contre le Cancer (Comité du Finistère).

Introduction

Familial prostate cancer (PCa) accounts for 20-25% of all cases and targeted screening is recommended in first degree relatives (FDR) of PCa patients. We aimed to support its interest by demonstrating higher risk and earlier onset in these families.

Methods

we obtained a serum PSA testing yearly, in a 8-year screening program, in 660 FDR (brothers or sons) aged 40-70 of PCa patients treated, between 1994-1997 in three french centers. We report here the screening results in group aged 50-70. The familial PCa status of the screening candidates, was divided in: hereditary (HR) status (3+PCa:10,6%), familial without obvious hereditary pattern (FNH) (2PCa:19%) or sporadic (1PCa:70%). Prostatic biopsies (PBx) were performed when PSA >4ng/mL, until 2002, while when PSA >2.5ng/mL thereafter.

Results

315 men (mean age 58y) had the first year assessment (Table). PSA level was >4ng/ml, at least for one of the 8 assessments, for 163 men: 1) PBx diagnosed 34 PCa, 2) were negative in 43 cases, 3) were not performed in 90 cases: control of PSA < 2.5ng/ml 12/90 (13%), patient refusal 16/90 (18%), not necessary according to the FDR urologist 18/90 (20%). Positive predictive value (PPV) of PSA >4ng/ mL was high 34/77 (45%). In addition, 313 men had PSA levels >2.5 and ?4ng/mL : PBx 1) diagnosed 25 CaP, 2) were negative in 20 cases, 3) were not done in 113 cases (36%) as not indicated at that time (before 2002); PPV in this PSA range was high 25/45 (56%) ; 7 PCa (12%) were discovered in 7 FDR for PSA <2.5ng/mL in the year before diagnosis. Moreover the proportion of men with PSA >4ng/ml was significantly higher in relatives with familial PCa status (2+PCa vs. 1PCa) and in early onset PCa families (?65y vs. >65y): 30,5% vs 40% (p=0.05) and 59% vs 22% (p<0.001) respectively. In the same way PCa detection was significantly increased in relatives with familial PCa status (2+PCa vs. 1PCa) and in early onset PCa families (? 65y vs. >65y): 21% vs 8,5% (p<0.001) and 17,4% vs 9,9% (p=0,031) respectively.

Conclusions

Our results confirm prospectively the high risk of PCa in FDR, particularly for relatives with familial CaP status (2+PCa) and in early onset families (? 65y). Those findings suggest, targeted screening in families with HR status but also with FNH status and in sporadic families with early onset.

Funding

Programme Hospitalier de Recherche Clinique, Ligue Nationale contre le Cancer (Comité du Finistère).