A family history of a hereditary cancer syndrome is associated with an increased risk of biopsy progression on prostate cancer (PCa) active surveillance (AS), according to a poster presentation at the virtual 2021 Genitourinary Cancers Symposium.
Keyan Salari, MD, PhD, of Massachusetts General Hospital in Boston, Massachusetts, and colleagues calculated family history scores for 958 men enrolled in AS from 1997 to 2019. Each patient’s score incorporated the number of his relatives with PCa or hereditary cancer syndrome, a BRCA1/2-related prostate, breast, ovarian, and/or pancreatic cancer.
In univariate analysis, a strong family history of more than 1 first-degree relative equivalent with a hereditary cancer syndrome was significantly associated with a 37% increased risk of biopsy progression, Dr Salari reported. A strong family history of any PCa was not.
In multivariate analysis, having a strong family history of a hereditary cancer syndrome significantly and independently predicted a 42% higher risk of biopsy progression, after adjustments for age, percent core involved with cancer on initial biopsy, and PSA density. Family history did not predict adverse features on surgical pathology or biochemical recurrence.
“Most patients with a strong family history of these cancers test negative for known germline genetic mutations despite the suggestion of a hereditary cancer syndrome running in the family,” Dr Salari said.. “Irrespective of specific genetic mutations, just having a strong family history of these cancers increased the risk of progression on active surveillance by 40-50%.”
Having either a germline mutation or a strong family history should not disqualify patients who are otherwise appropriate candidates for AS, he added.
“I believe the information should be an important part of the conversation when counseling patients deciding on surveillance versus treatment, Dr Salari said. “It is important for these men to adhere to a standardized active surveillance schedule including PSA testing, imaging with multiparametric MRI, and periodic prostate biopsies to ensure disease progression is detected in a timely manner if it occurs.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Schneider A, Bowler N, Fogg R, et al. The impact of a positive family history on clinical and pathologic outcomes of active surveillance for prostate cancer. Poster presented at the virtual 2021 Genitourinary Cancers Symposium; February 11 to 13. Abstract 225.