Ae. Norrish et al., A population-based study of clinical and pathological prognostic characteristics of men with familial and sporadic prostate cancer, BJU INT, 84(3), 1999, pp. 311-315
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.