Selection criteria for the patients to consider the active surveillance strategy are the biopsy Gleason Grade Group, prostate-specific antigen (PSA) level, and clinical tumor stage in addition to various other criteria. Previous studies have shown that about one-third of the initial classifications in biopsies (Gleason Grade Groups and tumor stages) are assumed to be too low compared to the classification after radical prostatectomy, resulting in postoperative upgrading and upstaging.2-5
There are different reasons why patients could opt for definitive treatment such as surgery or radiotherapy. One of them may be the concern of having a higher risk of undetected high grade or high stage disease that has not been investigated. This concern could be due to positive family history or a fatal family history of prostate cancer.
The aim of this study was to assess whether family history or fatal family history is associated with rates of postoperative upgrading and upstaging among men with low risk and favorable intermediate-risk prostate cancer in order to provide guidance on clinical decision making for active surveillance for these patients.
In multiple regression analyses, results from the current study indicated no detrimental effect of a positive family history or a fatal family history on postoperative upgrading or upstaging. Additionally, a separate regression analysis for upgrading and upstaging of the entire cohort was conducted to gain more statistical power. In this analysis, neither a positive family history nor a fatal family history of prostate cancer was associated with a higher likelihood of upgrading and upstaging, respectively.
This study shows that a positive family history or a fatal family history of prostate cancer in patients with low-risk or favorable intermediate-risk should not be the reason to decide against active surveillance.
Written by: Nikola Maier, MD, and Valentin H. Meissner, MD, Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
References:
- Mohler, James L., Andrew J. Armstrong, Robert R. Bahnson, Anthony Victor D'Amico, Brian J. Davis, James A. Eastham, Charles A. Enke et al. "Prostate cancer, version 1.2016." Journal of the National Comprehensive Cancer Network 14, no. 1 (2016): 19-30.
- Peters, Justin, Laurence Harewood, Anthony Costello, Christopher Hovens, and Niall Corcoran. "Underestimation of Gleason score at prostate biopsy reflects sampling error in lower volume tumors." (2012).
- Morlacco, Alessandro, John C. Cheville, Laureano J. Rangel, Derek J. Gearman, and R. Jeffrey Karnes. "Adverse disease features in Gleason score 3+ 4 “favorable intermediate-risk” prostate cancer: implications for active surveillance." European urology 72, no. 3 (2017): 442-447.
- Kaye, Deborah R., Ji Qi, Todd M. Morgan, Susan Linsell, Kevin B. Ginsburg, Brian R. Lane, James E. Montie, Michael L. Cher, David C. Miller, and Michigan Urological Surgery Improvement Collaborative. "Pathological upgrading at radical prostatectomy for patients with Grade Group 1 prostate cancer: implications of confirmatory testing for patients considering active surveillance." BJU international 123, no. 5 (2019): 846-853.
- Vellekoop, Annelies, Stacy Loeb, Yasin Folkvaljon, and Pär Stattin. "Population based study of predictors of adverse pathology among candidates for active surveillance with Gleason 6 prostate cancer." The Journal of urology 191, no. 2 (2014): 350-357.