A large nationwide cohort study in Sweden has found that men with a family history of prostate cancer have a greater risk of being diagnosed with an advanced phase of the disease making it more likely to be fatal. This has now warranted that screening guidelines be adjusted to include men with a family history of prostate cancer be advised to screen earlier for the disease than men in the general population.
Is prostate cancer an hereditary disease?
Family history is the strongest known risk factor for prostate cancer. Current guidelines do recommend that earlier screening for men with a family history of the disease is necessary. The problem, due to limited evidence-based guidance available, was at what age this earlier screening should start.
The purpose of the study was to provide precise recommendations about at what age should relatives of prostate cancer patients start screening based on the number of affected relatives and the age at onset of prostate cancer in the family.
Prostate cancer screenings for men with a family history of the disease aim to prevent a diagnosis at a later, less treatable stage. This is what has been lacking in current prostate cancer screening guidelines. Currently, guidelines do recommend men with a family history to be screened earlier but the question has always been, at what age to start these earlier screenings. This is where this study aimed to fill in the data on the limited evidence available by pinpointing at what age these men should begin screening for prostate cancer.
The study was a register-based nationwide cohort study of all men (aged 0 to 96) living in Sweden born after 1931 along with their fathers who were included. Follow-up occurred from 1958 to 2015 of more than 6.3 million men out of which 88,999 of those men were diagnosed with stage 3 or 4 prostate cancer or died from the disease.
Study conclusions
From the study data gathered, the researchers calculated the age at which men who had a father, brother, or son diagnosed with prostate cancer reached the “screening risk threshold,” meaning the same level of prostate cancer risk as those aged 50 years and older in the broader population. This is what many guidelines recommend for what age to begin prostate cancer screenings.
What the study found, however, were men with a family history of the disease, reached the screening risk threshold up to 12 years earlier than the general population. However, it becomes murkier due to the fact that men may reach this threshold at different ages, depending on how many of their first-degree relatives had prostate cancer and at what age those relatives were diagnosed. Based on these findings, researchers with the study concluded that men with a family history of prostate cancer reach a high enough risk to begin screening anywhere from 2 to 11 years earlier than the current recommendation.
This study took into account not only the number of relatives but also the age at onset of prostate cancer in the family members, which is an additional important piece of information to the guidelines. These results may contribute to more evidence-based personalized prostate cancer screening guidelines in clinic settings. This will further help clinicians inform men of a family history of prostate cancer to encourage individualized counseling of other male relatives in the family.
Overall, these findings validate the need for greater personalization of recommendations for prostate cancer screenings. It should not be based on a one-size-fits-all mentality as every man deserves guidance based on their family history, ethnicity, and lifestyle differences. By working with their urologist, this information provides men optimal care regarding prostate cancer screenings in order to diagnosis it early for the best outcome possible.
