Detection of subclinical cancers by prostate-specific antigen screening inasymptomatic men from high-risk prostate cancer families

Positive family history is a significant risk factor for prostate cancer. I mproved knowledge of the epidemiology and molecular basis of hereditary pro state cancer has led to a need for counseling and clinical follow-up for me n with a positive family history of prostate cancer. However, very little i nformation is available on the efficacy of early screening procedures, such as serum prostate-specific antigen (PSA) measurements, in the management o f genetically predisposed, high-risk individuals. In a nationwide study, we obtained family histories from 2099 Finnish prostate cancer patients and i dentified 302 families with two or more affected cases. Here, 209 asymptoma tic 45-75-year-old males from these families were included in a study to de termine the frequency of serum PSA positivity and the prevalence of subclin ical prostate cancers. Serum PSA was elevated in 21 (10.0%) of these high-r isk individuals. Seven prostate cancers (3.3%) and two high-grade prostatic intraepithelial neoplasia lesions were diagnosed, with three cancers occur ring in men ages less than or equal to 59 years. Men from prostate cancer f amilies,vith an average age of onset of <60 years had a significantly highe r frequency of PSA positivity (28.6%, P = 0.01) as well as cancers (14,3%, P = 0.02) than those with a later age of onset. The results suggest that pr ostate cancer development in genetically predisposed individuals is precede d by a subclinical period when PSA detection is possible. Serum PSA screeni ng may be particularly useful in men with a family history of early-onset p rostate cancer.