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Familial risk for prostate cancer: genetics vs. disease-seeking activity

Posted Aug 20 2010 12:00am

A study published yesterday in the Journal of the National Cancer Institute raises interesting questions about prostate cancer risk and family history of the disease.

Bratt et al. have used data from the Swedish national, population-based Prostate Cancer Database Sweden (PCBaSe Sweden) to explore the relationship between the risk for prostate cancer among 22,511 brothers of 13,975 index patients using so-called “standardized incidence ratios” (SIRs).

The results of their study showed that:

  • Brothers of index patients with prostate cancer were at increased risk for a diagnosis of prostate cancer (SIR = 3.1).
  • Risk was higher for T1c tumors (SIR = 3.4) than for metastatic tumors (SIR = 2.0).
  • Risk of T1c tumors was especially high

The authors conclude that men with a family history of prostate cancer seem to have a higher probability of diagnostic activity, which then appears to contribute to their increased risk of prostate cancer and also to detection bias in epidemiological and genetic studies of familial prostate cancer.

In an interesting editorial commentary in the same issue of the journal, Thompson et al. discuss this article and the complexities of using PSA testing to assess risk for prostate cancer today. They conclude with the interesting statement that:

Perhaps the best tactic would be to change our approach from seeking risk factors for prostate cancer (a disease that is ubiquitous, with many patients probably being better off if it were not detected by screening) to an assessment of factors related to biologically consequential prostate cancer (i.e., metastatic disease or prostate cancer-specific death).

Additional information about this study can be found in an article on the HealthDay web site .

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