The influence of family history on prostate cancer risk: Implications for clinical management
BJU International , Volume 107 - Issue 5 p. 716- 721
What's known on the subject? and What does the study add? A family history of prostate cancer has long been identified as an important risk factor for developing the disease. This risk factor can be easily assessed in clinical practice and current guidelines recommend to initiate prostate cancer early detection 5 years earlier (i.e. around the age of 40 years) than in men without a positive family history. This review elucidates the close association between the proximity of relatedness, greater number of affected family members and earlier age at diagnosis of the family members and prostate cancer risk. The evidence for prostate cancer risk reduction by 5α-reductase inhibitors has potential to expand management options for men at high risk for developing prostate cancer beyond more frequent and/or earlier surveillance. The most recent evidence for the link between a family history of prostate cancer and individual risk for future disease was examined, with the aim of understanding what the existence and nature of a family history of prostate cancer does to a man's risk of developing the disease. Our findings highlighted the clear association between a family history of prostate cancer and increased risk of developing the disease; with a greater proximity of relatedness, greater number of family members affected and/or earlier age at diagnosis of the family member elevating risk further. These findings have important clinical implications for the identification and subsequent management of men deemed to be at increased risk of developing prostate cancer. The evidence for prostate cancer risk reduction with the mono 5α-reductase inhibitor (5ARI) finasteride in a low-risk population and, more recently, with the dual 5ARI dutasteride in a population at increased risk of developing the disease, has potential to expand management options for men at risk of developing prostate cancer beyond more frequent and/or earlier surveillance. Given that family history can be easily assessed in routine clinical practice, it should be regarded as an important parameter to consider alongside PSA level for prostate cancer risk assessment.