A population-based study of clinical and pathological prognostic characteristics of men with familial and sporadic prostate cancer

Objectives To compare traditional prognostic characteristics of familial vs sporadic prostate cancers and to investigate potential detection biases ar ising from differences in the use of screening and investigative procedures . Patients and methods Familial and sporadic cancers were identified in a pop ulation-based sample of incident prostate cancers (total 318) in Auckland, New Zealand. To examine the potential for detection biases in these compari sons, the sociodemographic and clinical characteristics were determined acc ording to family history status for a sample of 959 patients newly referred to Auckland urology clinics by general practitioners for the investigation of prostate-related conditions. Results Compared with sporadic prostate cancers, familial cancers were more likely to be diagnosed in patients at a younger age (P=0.05), after asympt omatic serum prostate-specific antigen (PSA) screening (P=0.02), and to inc lude a lower proportion with extraprostatic disease (P=0.009) and serum PSA levels before diagnosis of >20 ng/mL (P=0.04). This was consistent with th e observed trend for patients referred to urology clinics with a positive f amily history to be of higher socio-economic and educational status and to more frequently undergo screening and biopsy investigation. Conclusion Familial prostate cancers appeared to be diagnosed at an earlier stage of disease progression in this study population, possibly as the res ult of the higher socio-economic status and greater use of screening and in vestigative procedures amongst patients reporting a positive family history . These features reduce the validity of cross-sectional comparisons of prog nostic variables for familial vs sporadic prostate cancer and emphasize the need for further longitudinal prognostic studies.