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 CancerDatabase Sweden (PCBaSe Sweden) to explore the relationship between the risk for prostatecancer 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 increasedrisk 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 wasespecially high
The authors conclude that men with a family historyof prostate cancer seem to have a higher probability of diagnostic activity, which then appears to contribute to their increasedrisk of prostate cancer and also to detection bias in epidemiologicaland 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 wouldbe to change our approach from seeking risk factors for prostatecancer (a disease that is ubiquitous, with many patients probablybeing better off if it were not detected by screening) to anassessment of factors related to biologically consequentialprostate cancer (i.e., metastatic disease or prostate cancer-specificdeath).