Investigators who categorized men with prostate cancer according to the strength of their family history of the disease found that the stronger the history, the better their overall survival.
In the longitudinal, multi-institutional UK Genetic Prostate Cancer Study of 16,340 men with prostate cancer, those with a family history of 1 relative (first or second degree) with prostate cancer had a significant 15% lower risk of all-cause mortality compared with those who had no such family history, Mark N. Brook, PhD, of The Institute of Cancer Research in London, UK, and colleagues reported in European Urology. Men with a family history of 2 or more relatives with prostate cancer had a significant 20% lower risk. Men with a family history of at least 1 first-degree relative with prostate cancer had a significant 18% lower risk.
“Based on the investigation of the type and timing of relatives’ cancers, it is likely that reductions in mortality are due almost completely to a greater awareness of the disease,” the investigators concluded.
Continue Reading
In an interview, Dr Brook related, “We looked at the timing of patient’s diagnoses compared to their relatives and found that if patients were diagnosed before their relatives — that is, they likely had no awareness of prostate cancer in the family — then this difference in survival went away.”
The findings show the importance of screening and awareness programs, which are likely to improve survival among men with a family history of prostate cancer, according to the investigators.
As the study included men who already had prostate cancer, it does not address the effectiveness of PSA screening. “However, it does seem that the reductions in mortality may be driven by awareness, which indicates the importance of screening and awareness programs. This study is large and comprehensive in its clinical information and follow-up, allowing us to account for other explanations,” Dr Brook said.
Regarding study limitations, the authors acknowledged that they lacked data on other epidemiologic risk factors for death, such as smoking. They also noted that they did not have information on comorbidities, “which may be one of the principal predictors of mortality.” Further, the investigators pointed out that approximately 90% of the study population was of European ancestry, which they said is an under-representation of individuals of other ethnicities.
Jeffrey Tosoian, MD, MPH, an assistant professor in the Department of Urology at Vanderbilt University Medical Center in Nashville, Tennessee, said this study is novel because it presents a new way of thinking about family history of cancer. “Clinically, I think we often assume that family history of a given cancer is a negative prognostic factor associated with poorer outcomes,” Dr Tosoian said. “This is a well done study in a large population, which in fact found the opposite, and a stronger family history of prostate cancer was associated with increased survival among patients diagnosed with prostate cancer.”
The authors’ conclusions that this is most likely due to increased awareness and potentially more vigilant screening and monitoring among these patients is supported by some of the secondary outcomes they present. “Although family history is only one of several considerations when weighing the risks and benefits of screening, the findings could support clinicians in emphasizing the importance of screening and monitoring in patients with a family history of prostate cancer,” Dr Tosoian said.
“I am personally not surprised by the findings, as they are intuitive, and the authors should be commended for the astute hypothesis used for their research,” said Andres Correa, MD, a urologic oncologist and an assistant professor of surgery at Fox Chase Cancer Center in Philadelphia, Pennsylvania.
The study helps set some of the groundwork on awareness research and how best to spend resources dedicated for the various initiatives, he noted. “The study shows that a shared experience is important for disease awareness to be impactful, and this should be the message in the awareness campaigns,” he said. “Of paramount importance is to study how these awareness campaigns impact cancer outcomes in minority populations in the US, who tend to present with more advance stages and have been shown to have worse disease outcomes.”
The new study provides important evidence about prostate cancer awareness and improvements in prostate cancer outcomes. A significant amount of effort and capital has been spent on prostate cancer awareness campaigns, but their impact on prostate cancer outcomes remain inconclusive, he said. “I believe the study is important as it provides evidence of the impact of disease awareness on cancer outcomes,” Dr Correa said.
Reference
Brook MN, Ní Raghallaigh H, Govindasami K, et al. Family history of prostate cancer and survival outcomes in the UK Genetic Prostate Cancer Study. Eur Urol. Published online December 16, 2022. doi:10.1016/j.eururo.2022.11.019
