Age specific risks of familial prostate carcinoma: a basis for screening recommendations in high risk populations

A positive family history is one of the strongest known risk factors for prostate carcinoma in addition to age and race. In this article, the authors present age specific risks for developing prostate carcinoma in families with an aggregation of prostate carcinoma.

Data from a population-based cohort study including 5706 sons of Swedish men who had been diagnosed with prostate carcinoma between 1959 and 1963 were used. The age specific incidence rates were calculated for different cohorts of prostate carcinoma families with respect to patient age at the time of prostate carcinoma diagnosis and the number of men affected.

Both patient age at the time of prostate carcinoma diagnosis and the number of men affected in the families influenced the risk of developing prostate carcinoma significantly. Unaffected men in families with two or more cases of prostate carcinoma have a very high risk of developing prostate carcinoma at a young age. The cumulative risks in these families are 5%, 15%, and 30% by ages 60 years, 70 years, and 80 years, respectively, compared with only 0.45%, 3%, and 10%, respectively, at the same ages in the general population.

The findings of the current study together with data from the literature support the case for the screening of high risk families. The authors also conclude that men with at least two close relatives with prostate carcinoma have a very high risk of developing prostate carcinoma before age 70 years. The authors recommend these men undergo testing for prostate specific antigen and a digital rectal examination annually between the ages 50 years 70 years, ages at which patients usually are offered curative treatment for localized tumors. Screening of individuals before age 50 years may be recommended in selected families with a history of prostate carcinoma of very early onset.