Men with a positive family history of prostate cancer (PCa) have an increased risk of low-grade but not aggressive PCa, according to a new study.

Marco Randazzo, MD, of the University Hospital Zürich, Zürich, Switzerland, and colleagues studied 4,932 men who participated in the Swiss arm of the European Randomised Study of Screening for Prostate Cancer with systematic PSA level tests every 4 years. Of these, 334 (6.8%) had a positive family history of PCa (reported first-degree relatives diagnosed with PCa). The cumulative PCa incidence was 18% in group with a positive family history compared with 12% in those with a negative family history. The 2 groups had no significant differences in PSA level at diagnosis, biopsy Gleason score, or pathologic Gleason score among men who underwent radical prostatectomy.

On multivariate analysis, age, family history, and baseline PSA independently predicted overall PCa incidence, Dr. Randazzo’s group reported online ahead of print in BJU International. Only baseline PSA level independently predicted a biopsy Gleason score of 7 or higher.

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Regardless of family history, the researchers concluded, the current PSA-based screening setting detects the majority of aggressive PCa cases and misses only a minority of interval cancers with a 4-year screening algorithm.