Effects of Prostate-Specific Antigen Testing on Familial Prostate Cancer Risk Estimates

• Published in: JNCI : Journal of the National Cancer Institute Vol. 102; no. 17; pp. 1336 - 1343
• Main Authors: Bratt, Ola, Garmo, Hans, Adolfsson, Jan, Bill-Axelson, Anna, Holmberg, Lars, Lambe, Mats, Stattin, Pär
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 08.09.2010; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Antigens; Biological and medical sciences; Biomarkers, Tumor - blood; Cancer and Oncology; Cancer och onkologi; Clinical Medicine; Cohort Studies; Confidence Intervals; Databases, Factual; Early Detection of Cancer - methods; Heredity; Humans; Incidence; Kirurgi; Klinisk medicin; Male; Medical and Health Sciences; Medical diagnosis; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Middle Aged; Neoplasm Staging; Nephrology. Urinary tract diseases; Observer Variation; Odds Ratio; Oncology; Onkologi; Prostate cancer; Prostate-Specific Antigen - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - genetics; Prostatic Neoplasms - immunology; Prostatic Neoplasms - pathology; Registries; Risk Assessment; Risk Factors; Socioeconomic Factors; Studies; Surgery; Sweden - epidemiology; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Sweden; Prostate specific antigen; Urinary system disease; Cancerology; Prostate disease; Risk factor; Familial cancer; Tumoral marker; Malignant tumor; Medical screening; Male genital diseases; Prostate cancer; Cancer
• ISSN: 0027-8874; 1460-2105; 1460-2105
• DOI: 10.1093/jnci/djq265

Background Family history is a strong risk factor for prostate cancer. The aim of this study was to investigate whether increased diagnostic activity is related to the incidence of prostate cancer among brothers of men with prostate cancer. Methods Data were from the nationwide population-based Prostate Cancer Database Sweden (PCBaSe Sweden), which includes data from the National Prostate Cancer Register, the Swedish Cancer Register, the Register of the Total Population, the Multi-Generation Register, and the Census database. We investigated the relationship of tumor characteristics, time from diagnosis of the index patient (ie, prostate cancer patients in the National Prostate Cancer Register for whom at least one brother and their father could be identified), calendar period, geographic factors, and socioeconomic status to standardized incidence ratios (SIRs) for prostate cancer among 22 511 brothers of 13 975 index patients in PCBaSe Sweden. Results Brothers of index patients with prostate cancer were at increased risk for a diagnosis of prostate cancer (SIR = 3.1, 95% confidence interval [CI] = 2.9 to 3.3). Risk was higher for T1c tumors (SIR = 3.4, 95% CI = 3.2 to 3.8) than for metastatic tumors (SIR = 2.0, 95% CI = 1.5 to 2.6), and risk of T1c tumors was especially high during the first year after the diagnosis of the index patient (SIR = 4.3, 95% CI = 3.8 to 4.9), compared with the following years (SIR range = 2.8–3.3), and for brothers of index patients who had a higher socioeconomic status (SIR = 4.2, 95% CI = 3.7 to 4.7), compared with brothers of index patients with lower socioeconomic status (SIR = 2.8, 95% CI = 2.4 to 3.2). Conclusions Increased diagnostic activity among men with a family history of prostate cancer appears to contribute to their increased risk of prostate cancer and to lead to detection bias in epidemiological and genetic studies of familial prostate cancer.