European urology oncology · 2025
Family History of Prostate, Breast, Ovarian, and/or Pancreatic Cancer and Associations with Grade Reclassification in a Large Prostate Cancer Active Surveillance Cohort.
СтатьяНазвание и аннотация: Перевод в очереди
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de la Calle Claire M, Jing Yuezhou, Fountain Julia, Fletcher Sean A, Mamawala Mufaddal M, Landis Patricia, Macura Katarzyna J, Lotan Tamara L, Trock Bruce J, Isaacs William B, Pavlovich Christian P
Аннотация
BACKGROUND AND OBJECTIVE: The effect of family history (FH) on prostate cancer active surveillance outcomes is unknown. Our objective is to evaluate FH of prostate, breast, ovarian, and/or pancreatic cancer in a large prospective active surveillance cohort.
METHODS: Patients with recorded FH data (N = 1421) were selected. Association between grade reclassification to Gleason grade (GG) ≥2 and GG ≥3, and FH of prostate cancer (FH-Pr); FH of breast, ovarian, and/or pancreatic cancer (FH-BOPa); and FH-Pr and/or FH-BOPa in first-degree relatives was evaluated by a competing risk analysis. Association with adverse pathologic features (APFs; GG ≥3, seminal vesicle, and/or lymph node involvement) at radical prostatectomy was assessed with multivariable logistic regression.
KEY FINDINGS AND LIMITATIONS: Of the 1421 patients, 41/362 (11.3%) with FH-Pr, 37/336 (11.0%) with FH-BOPa, and 67/600 (11.2%) with FH-Pr and/or FH-BOPa were reclassified to GG ≥3. FH-Pr was associated with reclassification to GG ≥2 and GG ≥3 (adjusted hazard ratio [HR] 1.49 for GG ≥3 [95% confidence interval {CI} 1.02-2.17], p = 0.039), as was FH-Pr and/or FH-BOPa (HR 1.52 for GG ≥3 [95% CI 1.07-2.17], p = 0.020). FH-BOPa however was not associated with any grade reclassification (HR 1.30 for GG ≥3 [95% CI 0.88-1.94], p = 0.190). In the 349 patients who underwent radical prostatectomy, no FH status was associated with APFs. Our study is limited by having information on first-degree relatives only.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients with FH-Pr had a higher risk of grade reclassification, including extreme grade reclassification (GG ≥3), but no FH status led to more APFs at radical prostatectomy. Patients with FH can safely be managed on surveillance, but might benefit from closer monitoring.
METHODS: Patients with recorded FH data (N = 1421) were selected. Association between grade reclassification to Gleason grade (GG) ≥2 and GG ≥3, and FH of prostate cancer (FH-Pr); FH of breast, ovarian, and/or pancreatic cancer (FH-BOPa); and FH-Pr and/or FH-BOPa in first-degree relatives was evaluated by a competing risk analysis. Association with adverse pathologic features (APFs; GG ≥3, seminal vesicle, and/or lymph node involvement) at radical prostatectomy was assessed with multivariable logistic regression.
KEY FINDINGS AND LIMITATIONS: Of the 1421 patients, 41/362 (11.3%) with FH-Pr, 37/336 (11.0%) with FH-BOPa, and 67/600 (11.2%) with FH-Pr and/or FH-BOPa were reclassified to GG ≥3. FH-Pr was associated with reclassification to GG ≥2 and GG ≥3 (adjusted hazard ratio [HR] 1.49 for GG ≥3 [95% confidence interval {CI} 1.02-2.17], p = 0.039), as was FH-Pr and/or FH-BOPa (HR 1.52 for GG ≥3 [95% CI 1.07-2.17], p = 0.020). FH-BOPa however was not associated with any grade reclassification (HR 1.30 for GG ≥3 [95% CI 0.88-1.94], p = 0.190). In the 349 patients who underwent radical prostatectomy, no FH status was associated with APFs. Our study is limited by having information on first-degree relatives only.
CONCLUSIONS AND CLINICAL IMPLICATIONS: Patients with FH-Pr had a higher risk of grade reclassification, including extreme grade reclassification (GG ≥3), but no FH status led to more APFs at radical prostatectomy. Patients with FH can safely be managed on surveillance, but might benefit from closer monitoring.