Abstract: PD07-11
Sources of Funding: Programme Hospitalier de Recherche Clinique, Ligue Nationale contre le Cancer (Comité du Finistère)

Introduction

Targeted screening in high risk families due to familial aggregation, is recommended as early as 40-45 years in first degree relatives (FDR) of prostate cancer (PCa) patients according to high risk and early onset of the disease. We aimed to assess this concept in FDR 40-49 years old (yo).

Methods

We obtained a serum PSA testing, yearly, in a 8-year PCa screening program, in 345 FDR (brothers or sons), 40-49 yo, of PCa patients treated, between 1994-1997. A systematic genealogical analysis previously performed, allowed to define the familial PCa status: at least 1 PCa in the family (range: 1-7), so the screened men were classified into: hereditary status (3+ PCa:11.3%), familial without obvious hereditary pattern (2 PCa:19.2%) or sporadic (1 PCa:69.5%). Prostatic biopsies (PBx) were performed when PSA >4ng/mL, until 2002, while when PSA >2.5ng/mL therafter.

Results

Mean age at screening was 45.5y. A total of 1344 screening tests were performed during this program (Table)._x000D_ Of the 345 screened men, 21 (6%) had at least one PSA level > 4 ng/ml of the 8 assessments (Table). PBx: diagnosed 7 PCa (2%) in 41, 43, 44, 45, 46 and 48 (2 cases) yo men, were negative in 5 relatives, were not done in 9 cases (1 refusal, 2 due to other medical problem, 6 due to control PSA <4ng/ml including 3 cases <2.5ng.ml). The positive predictive value of PSA >4ng/mL was 7/12 (58%). The proportion of men with PSA >4ng/mL in 2+ PCa families was significantly higher than in sporadic families: 2.9% vs 0.9% (p=0.013). In addition, 37 relatives (10.7%) had at least one PSA level >2.5ng/mL and <4ng/mL, and PBx diagnosed 2 more PCa (43 and 47 yo.) and most frequently were not done due to not indicated at that time (before 2003). Of the 208 relatives with PSA <1ng/mL at baseline: none had PSA >2.5ng/mL during the 4 consecutive years, while 7 had PSA >2.5ng/mL at 6th round (n=2), 7th round (n=4) and 8th round (n=1), the latter being diagnosed with PCa at 50 yo._x000D_

Conclusions

Those results suggest that PCa is not frequent in 40-49 yo. FDR, however diagnosed in 9/345 (2.6%) of cases of whom 4 times before 45 y. Therefore we recommend to start screening as soon as 40 yo. in high risk families with annual PSA testing, except when baseline PSA is <1ng/mL case in which next PSA testing may be performed 5 years later.

Funding

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