Familial risk and familial survival in prostate cancer

The Swedish Family-Cancer Database has been the major source of population-based prospective data on familial risks on most cancers, including prostate cancer. In the present review, I focus on three lines of family studies with novel results.

The covered studies originate from the same database with publication dates spanning a period of somewhat over 3 years. Age-specific hazard ratios (HRs) of incident prostate cancer and fatal prostate cancer were determined according to the number of affected relatives. Cumulative risks for incidence and death were calculated for the various types of families. Finally, data on the familial association of prostate cancer with some other cancers were reviewed.

If the father had prostate cancer, the HR for sons was 2.1 and it increased to 17.7 when three brothers were affected. The highest HR (23) was observed for men before age 60 years with three affected brothers. The patterns for fatal familial prostate cancer were similar. Other reviewed sets of data showed evidence for the familial concordance of good and poor survival in prostate cancer. Familial risks were somewhat higher for fatal than for incident prostate cancer, suggesting that fatal prostate cancers may be a genetic subgroup.

Considering the high familial risks in fatal prostate cancer, family history remains an important prognostic piece of information useful for clinical genetic counseling. Obviously, preventive measures for at-risk men are needed but these are beyond the present paper. Starting screening before any prostate cancers are diagnosed in a family appears counterproductive.