PCa: How positive family history predicts outcomes

Urology Times SUO internship program member Cory Hugen, MD, reports on a recent Mayo Clinic study on familial history’s impact on post-RP outcomes and survival.

UT SUO 2015 Internship Member Profile

Dr. Hugen is a clinical instructor and urologic oncology fellow at the University of Southern California, Los Angeles. During the Society of Urologic Oncology 2015 winter meeting, he was one of several urologic oncology fellows to contribute articles to Urology Times through a collaborative “UT SUO Internship.” Urology Times extends its thanks to all of the fellows and the Society of Urologic Oncology for participating in this unique partnership. For other articles in this series, click here.

Washington-A positive family history for prostate cancer may predict pathologic and clinical outcomes following radical prostatectomy.

According to new research presented at the 2015 Society of Urologic Oncology annual meeting in Washington, men with a positive family history for prostate cancer are more likely to have lower risk disease at diagnosis, organ-confined disease at the time of surgery, and improved cancer-specific and overall survival.

Researchers from Mayo Clinic in Rochester, MN identified 16,472 men who underwent radical prostatectomy between 1987 and 2010. Of these men, 5,323 reported a positive family history of prostate cancer. When pathologic outcomes were compared, men with a positive family history of prostate cancer were more likely to have low-risk disease at the time of diagnosis (47.7% vs. 43.0%, p<.0001) and organ-confined disease at the time of radical prostatectomy (79.2% vs. 74.4%, p<.0001) compared with men without a family history of prostate cancer.

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When the authors compared differences in survival, they found that men with a positive family history of prostate cancer had significantly increased 10-year cancer-specific survival (99% vs. 97%, p<.001) and overall survival (92% vs. 85%, p<.001) compared with men with a negative family history.

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The data were then analyzed using multivariable analysis, and family history retained statistical significance and demonstrated reduced cancer-specific mortality (HR 0.65, 95% CI: 0.500-0.832, p=.0007) and all-cause mortality (HR 0.68, 95% CI: 0.622-0.745, p<.0001).

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“This study shows that men with a positive family history of prostate cancer who undergo radical prostatectomy have improved cancer-specific and overall survival. We believe that family history information could be used to improve risk stratification and preoperative counseling for men considering surgery for prostate cancer,” said first author Mary E. Westerman, MD, who worked on the study with Stephen Boorjian, MD, and colleagues.

Whether the differences seen between men with and without a positive family history of prostate cancer are due to earlier diagnosis and stage migration due to increased screening was not evaluated in this study and would certainly warrant further investigation.