FAMILY HISTORY OF PROSTATE-CANCER IN PATIENTS WITH LOCALIZED PROSTATE-CANCER - AN INDEPENDENT PREDICTOR OF TREATMENT OUTCOME

Purpose: To determine if familial prostate cancer patients have a less favorable prognosis than patients with sporadic prostate cancer after treatment for localized disease with either radiotherapy (RT) or radi cal prostatectomy (RP). Patients and Methods: One thousand thirty-eigh t patients treated with either RT (n = 583) or RP (n = 455) were inclu ded in this analysis, These patients were noted as having a positive f amily history if they confirmed the diagnosis of prostate cancer in a first-degree relative, The outcome oi: interest was biochemical relaps e-free survival (bRFS). We used proportional hazards to analyze the ef fect of the presence of family history and other potential confounding variables (ie, age, treatment modality, stage, biopsy Gleason sum [GS ], and initial prostate-specific antigen [iPSA] levels) on treatment o utcome. Results: Eleven percent of all patients had a positive family history, The 5-year bRFS rates for patients with negative and positive family histories were 52% and 29%, respectively (P < .001). The poten tial confounders with bRFS rates were iPSA levels, biopsy GS, and clin ical tumor stage; treatment modality and age did not appear to be asso ciated with outcome. After adjusting for potential confounders, family history of prostate cancer remained strongly associated with biochemi cal failure. Conclusion: This is the first study to demonstrate that t he presence of a family history of prostate cancer correlates with tre atment outcome in a large unselected series of patients. Our findings suggest that familial prostate cancer may have a more aggressive cours e than nonfamilial prostate cancer, and that clinical and/or pathologi c parameters may not adequately predict this course. (C) 1997 by Ameri can Society of Clinical Oncology.