PD17-05 THE IMPACT OF A POSITIVE FAMILY HISTORY OF HEREDITARY CANCER-ASSOCIATED MALIGNANCIES ON OUTCOMES OF ACTIVE SURVEILLANCE FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD17)1 Sep 2021PD17-05 THE IMPACT OF A POSITIVE FAMILY HISTORY OF HEREDITARY CANCER-ASSOCIATED MALIGNANCIES ON OUTCOMES OF ACTIVE SURVEILLANCE FOR PROSTATE CANCER Adam Schneider, Nicholas Bowler, Ryan Fogg, Joon Yau Leong, Andrew Gusev, Adam Feldman, Michael Blute, Anthony Zietman, Douglas Dahl, Jason Efsathiou, Thenappan Chandrasekar, and Keyan Salari Adam SchneiderAdam Schneider More articles by this author , Nicholas BowlerNicholas Bowler More articles by this author , Ryan FoggRyan Fogg More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , Andrew GusevAndrew Gusev More articles by this author , Adam FeldmanAdam Feldman More articles by this author , Michael BluteMichael Blute More articles by this author , Anthony ZietmanAnthony Zietman More articles by this author , Douglas DahlDouglas Dahl More articles by this author , Jason EfsathiouJason Efsathiou More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , and Keyan SalariKeyan Salari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001999.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is the preferred management strategy for men with low-risk prostate cancer (PCa). Germline testing for DNA repair gene mutations is now recommended for patients with newly diagnosed PCa and a strong family history (FH) of PCa or BRCA1/2-related cancers, as such mutations have been associated with more aggressive forms of the disease. Here, we investigated the impact of FH on AS outcomes, under the hypothesis that men at high genetic risk for PCa are at greater risk for progression to treatment on AS. METHODS: We retrospectively reviewed detailed FH data of 958 patients from our institutional database of men enrolled in AS between 1997-2019. Data on FH of PCa and hereditary cancer syndrome (HCS) (BRCA1/2-related prostate, breast, ovarian and/or pancreatic cancers) were collected and integrated into a composite FH score incorporating the number of relatives with each cancer weighted by degree of relatedness. A strong FH was defined as a composite score representing >1 first-degree relative equivalent. The primary outcome was biopsy progression free survival (PFS) and secondary outcomes were adverse pathologic features at prostatectomy and biochemical recurrence. Statistical analysis was conducted using the Kaplan-Meier method and Cox proportional hazards regression. RESULTS: In univariate analysis, a strong FH suggestive of a HCS (HR 1.37 [1.03-1.90], P = 0.033; Figure 1) was associated with a significant increased risk of biopsy PFS; however, any FH of PCa (HR 1.10 [0.89-1.35], p=0.38) and a strong FH of PCa (HR 1.35 [0.92-1.98], p=0.13) were not significant. In multivariate analysis, a strong FH suggestive of a HCS remained a statistically significant predictor of biopsy PFS (HR 1.42 [1.03-1.96], p=0.03), after adjusting for age, percent core involvement on initial biopsy and PSA density. No significant association was found between FH and adverse features on surgical pathology or biochemical recurrence. CONCLUSIONS: A positive FH suggestive of a HCS is associated with an increased risk of biopsy PFS on AS and is an independent predictor of biopsy PFS. Men with such a FH may still be safely offered AS but should be counseled about the higher risk of progression. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e286-e286 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Schneider More articles by this author Nicholas Bowler More articles by this author Ryan Fogg More articles by this author Joon Yau Leong More articles by this author Andrew Gusev More articles by this author Adam Feldman More articles by this author Michael Blute More articles by this author Anthony Zietman More articles by this author Douglas Dahl More articles by this author Jason Efsathiou More articles by this author Thenappan Chandrasekar More articles by this author Keyan Salari More articles by this author Expand All Advertisement Loading ...