Elsevier

Urology

Volume 81, Issue 4, April 2013, Pages 826-830
Urology

Oncology
Does Positive Family History of Prostate Cancer Increase the Risk of Prostate Cancer on Initial Prostate Biopsy?

https://doi.org/10.1016/j.urology.2012.10.074Get rights and content

Objective

To assess the role of family history (FH) in the risk of a positive prostate biopsy (PBx) in a large North American biopsy population as earlier reports showed increased risk of prostate cancer (PCa) in men with a FH, but the risk has been limited to low grade prostate cancer in smaller studies, and the REDUCE trial found no such risk in North American patients.

Methods

We evaluated 4360 men undergoing initial extended biopsy (8-14 cores). Indications were elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). Variables including age, FH of PCa, race, PSA, and DRE results were included in our analysis to assess risk factors associated with PCa, high-grade prostate cancer (HGPCa), and low-grade prostate cancer (LGPCa).

Results

Two hundred sixty-eight patients had an FH of PCa whereas 4092 had negative FH. Positive biopsy was found in 1976 patients with HGPCa in 1149 and LGPCa in 827. Among 268 patients with an FH, overall PCa was found in 144 of 268 patients (54%); HGPCa in 79 of 144 patients (55%) and LGPCa in 65 of 144 patients (45%). FH was a significant risk factor for PCa, HGPCa, and LGPCa in univariate and multivariate analysis (P = .0001, .02, and .02, respectively). Also, FH was associated with high-risk benign pathology in the form of atypical small acinar cell proliferation (ASAP) or high-grade prostatic intraepithelial neoplasm (HGPIN) (P = .04).

Conclusion

Men in North America with an FH of PCa who undergo prostate biopsy are more likely to be diagnosed with both HGPCa and LGPCa.

Section snippets

Material and Methods

This is a single institutional study based on Cleveland Clinic experience. FH and all data were accessed via the institutional review board approved, Health Insurance Portability and Accountability Act-compliant, prostate cancer, and prostate biopsy databases. The FH of PCa for 4360 male patients who underwent an initial TRUS-guided PBx between March 2000 and February 2010, was reviewed and findings were subjected to two-tailed univariate and logistic regression multivariate analysis.

Candidates

Results

Overall, a total of 268 patients reported a positive FH of PCa, whereas 4092 patients had a negative FH of PCa. A total of 1976 patients (45%) had a positive initial PBx, whereas 2384 patients (55%) had a negative biopsy.

Among 268 patients with a FH positive for PCa, overall biopsy positive for PCa was found in 144 patients (54%), whereas a negative Bx was found in 124 patients (46%). Seventy-nine of 144 of these patients (55%) with positive FH of PCa were diagnosed with HGPCa, whereas 65

Discussion

As Dr. Ian Thompson has observed on many occasions, the greatest risk of being diagnosed with PCa is to undergo PBx.7 As a natural outcropping of this observation, we became concerned that the belief that FH increases the risk of PCa might simply lead to a lower threshold to perform biopsy on men with a positive FH. In the current study, univariate and multivariate analysis on 4360 patients in whom we had complete data, we found that there actually was a higher risk of prostate cancer, for both

Conclusions

In contrast to the REDUCE trial, we report that a positive FH of PCa increases the risk that North American patients undergoing initial prostate biopsy will be diagnosed with both HGPCa and LGPCa. Patients with biopsy negative for PCa, but who have a positive FH of the disease, have a significantly higher risk for being diagnosed with a high-risk pathology such as ASAP or HGPIN that increases the likelihood of a positive repeat biopsy.

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    Financial Disclosure: The authors declare that they have no relevant financial interests.

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