LOS ANGELES — Dad had prostate cancer. So did a brother. Does this mean a worse prognosis for the patient?
To answer this, researchers compared rates of freedom from biochemical failure in a retrospective study of 1,738 men treated with low-dose-rate brachytherapy alone or combined with external beam radio- therapy or hormone ablation. A history of prostate cancer in one or more first-degree relatives did not predict worse biochemical outcomes at 5 years, said Dr. Christopher A. Peters of Mount Sinai School of Medicine, New York, at the annual meeting of the American Society for Therapeutic Radiation and Oncology.
High-risk men with a positive family history had significantly better biochemical control (94% vs. 80% of men with no family history). In intermediate-risk patients, there was a trend toward better control in those with a positive family history (100% vs. 93%). Low-risk patients with a family history of prostate cancer had an actuarial freedom-from-biochemical-failure rate (95%) similar to those without a family history.
Family history was not a significant predictor, however, when its impact was weighed with that of other factors in a multivariate analysis. The only significant factors affecting prostate-specific antigen (PSA) failure at 5 years were use of hormone therapy, a biologically effective radiation dose >150 Gy, initial PSA level, and Gleason score.
“You can confidently say to the patient, 'You would not do any worse [because] you have your family history,'” Dr. Peters said in an interview.
He and his coauthors identified 2,652 consecutive patients with clinically localized prostate cancer who were treated with low-dose-rate brachytherapy alone or in combination with external beam radiotherapy or hormone ablation from 1992 to 2005. They found family history information for 1,738 of these patients, among whom 187 men (11%) had a first-degree relative with prostate cancer. The minimum follow-up for inclusion in the study was 2 years; median follow-up was 5 years.
Patients with a family history of prostate cancer were younger (median 65 years), compared with those with no history (67 years). Those without a family history also had significantly fewer low-dose implants (2.7% vs. 10.8%). Both findings were statistically significant.
A patient with a family history of prostate cancer won't do any worse because of that history. DR. PETERS