Abstract
PurposeTo assess whether a first-degree family history or a fatal family history of prostate cancer (PCa) are associated with postoperative upgrading and upstaging among men with low risk and favourable intermediate-risk (FIR) PCa and to provide guidance on clinical decision making for active surveillance (AS) in this patient population.MethodsParticipants in the German Familial Prostate Cancer database diagnosed from 1994 to 2019 with (1) low risk (clinical T1c–T2a, biopsy Gleason Grade Group (GGG) 1, PSA < 10 ng/ml), (2) Gleason 6 FIR (clinical T1c–T2a, GGG 1, PSA 10–20 ng/ml), and (3) Gleason 3 + 4 FIR (clinical T1c–T2a, GGG 2, PSA < 10 ng/ml) PCa who were subsequently treated with radical prostatectomy (RP) were analysed for upgrading, defined as postoperative GGG 3 tumour or upstaging, defined as pT3–pT4 or pN1 disease at RP. Logistic regression analysis was used to assess whether PCa family history was associated with postoperative upgrading or upstaging.ResultsAmong 4091 men who underwent RP, mean age at surgery was 64.4 (SD 6.7) years, 24.7% reported a family history, and 3.4% a fatal family history. Neither family history nor fatal family history were associated with upgrading or upstaging at low risk, Gleason 6 FIR, and Gleason 3 + 4 FIR PCa patients.ConclusionResults from the current study indicated no detrimental effect of family history on postoperative upgrading or upstaging. Therefore, a positive family history or fatal family history of PCa in FIR PCa patients should not be a reason to refrain from AS in men otherwise suitable.
Highlights
Active surveillance (AS) has emerged as a standard initial management option for low-risk prostate cancer (PCa) to reduce overtreatment and treatment-associated morbidity
Cancer family history included family history of PCa and other cancer, fatal family history, and secondary cancer of the patient. family history of PCa was stratified into hereditary PCa according to the Johns Hopkins criteria [18], first-degree relatives with PCa, and non-familial first-degree PCa
Results of this study showed that family history, defined as one or more first-degree relatives diagnosed with PCa including those with hereditary PCa, and fatal family history were not associated with postoperative upgrading or upstaging in men with low risk and favourable intermediate-risk (FIR) PCa
Summary
Active surveillance (AS) has emerged as a standard initial management option for low-risk prostate cancer (PCa) to reduce overtreatment and treatment-associated morbidity. National Comprehensive Cancer Network guidelines recommended AS as an option for men with favourable intermediate-risk (FIR) PCa [1]. Whether AS can be safely extended to FIR PCa patients remains a matter of debate [2,3,4]. Risk stratifications prior to treatment decisions are primarily based on biopsy Gleason Grade Group (GGG), clinical stage, and prostate-specific antigen (PSA) levels. Significant sampling error and morbidity associated with prostate biopsy complicates differentiation between aggressive and indolent disease so that post-radical prostatectomy (RP) upgrading and upstaging is common [5,6,7].
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