Journal of Clinical Oncology, Vol 15, 1478-1480, Copyright © 1997 by American Society of Clinical Oncology
Family history of prostate cancer in patients with localized prostate cancer: an independent predictor of treatment outcome
PA Kupelian, VA Kupelian, JS Witte, R Macklis and EA Klein
Department of Radiation Oncology, Cleveland Clinic Foundation, OH 44195, USA. kupelian@ccf.radonc.org
PURPOSE: To determine if familial prostate cancer patients have a less
favorable prognosis than patients with sporadic prostate cancer after
treatment for localized disease with either radiotherapy (RT) or radical
prostatectomy (RP). PATIENTS AND METHODS: One thousand thirty- eight
patients treated with either RT (n = 583) or RP (n = 455) were included in
this analysis. These patients were noted as having a positive family
history if they confirmed the diagnosis of prostate cancer in a
first-degree relative. The outcome of interest was biochemical relapse-free
survival (bRFS). We used proportional hazards to analyze the effect of the
presence of family history and other potential confounding variables (ie,
age, treatment modality, stage, biopsy Gleason sum [GS], and initial
prostate-specific antigen [iPSA] levels) on treatment outcome. RESULTS:
Eleven percent of all patients had a positive family history. The 5-year
bRFS rates for patients with negative and positive family histories were
52% and 29%, respectively (P < .001). The potential confounders with
bRFS rates were iPSA levels, biopsy GS, and clinical tumor stage; treatment
modality and age did not appear to be associated with outcome. After
adjusting for potential confounders, family history of prostate cancer
remained strongly associated with biochemical failure. CONCLUSION: This is
the first study to demonstrate that the presence of a family history of
prostate cancer correlates with treatment outcome in a large unselected
series of patients. Our findings suggest that familial prostate cancer may
have a more aggressive course than nonfamilial prostate cancer, and that
clinical and/or pathologic parameters may not adequately predict this
course.
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