Family history of prostate cancer and relapse after definitive external beam radiation therapy

Abstract

Purpose The influence of family history on outcome after definitive therapy for prostate cancer has been disputed. One series reported increased relapse rates in men with a positive family history of prostate cancer treated with radical prostatectomy or radiation therapy, whereas others have reported no difference in outcome. We examined our series of patients treated with definitive external beam radiation therapy to determine if a positive family history for prostate cancer is associated with better or worse outcome. Methods and materials Family history information was available for 538 patients treated with radiation therapy for prostate cancer between 1983 and 2001. Prostate cancer in one or more first-degree relatives (father, brother, or son) was considered a positive family history. The endpoint of interest was time to prostate-specific antigen failure or initiation of hormonal therapy after radiation therapy. Results Ninety-seven of 538 patients (18%) had a positive family history. There were no significant differences between the positive and negative family history groups. Family history had no effect on relapse-free survival rates in the entire cohort ( p = 0.94) or in any subgroup. African American patients with a positive family history had significantly worse 5-year relapse-free survival rates, although there were few patients in this subgroup. Neither family history nor race was a statistically significant predictor of relapse in multivariate analysis; however, combined African American race and positive family history was associated with worse relapse-free survival rates. Conclusions In this large study of patients receiving definitive radiation therapy for localized prostate cancer, no relationship was found between positive first-degree family history of prostate cancer and relapse. The influence of family history on clinical outcome may be more understandable once the gene or genes responsible for hereditary prostate cancer are identified.