ORLANDO – Screening men who are at high genetic risk for prostate cancer appears to provide a mortality benefit, according to an analysis of data from a randomized trial.
Of 73,200 men who participated in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and who had complete records available, 297 died of prostate cancer, 8,432 were considered high risk, and 5,326 had a known family history of the disease. Screening in the PLCO trial did not provide an overall mortality benefit, but genetic high risk was found to be associated with prostate cancer mortality (African Americans and whites with a family history of prostate cancer, for example, had odds ratios for mortality of 2.6 and 1.5, respectively), Dr. Michael Liss, a urologic oncology fellow at the University of California, San Diego, reported during a "Best Abstracts" presentation at the annual meeting of the American Urological Association.
Furthermore, the incidence of prostate cancer was higher among those with a family history than among those with no family history (16.7% vs. 10.7%), and those with a family history who were screened, compared with those who received usual care, had lower prostate specific antigen levels at diagnosis (5.8 vs. 6.5), a faster time to diagnosis (4.6 vs. 5.8 years), and a more favorable Gleason score (312 vs. 236 had a score less than 6, 120 vs. 129 had a score of 7, and 37 vs. 41 had a score greater than 8, for example).
In the current analysis of only those with a family history of prostate cancer, 9 who were screened, compared with 18 who were not, died of prostate cancer (hazard ratio, 0.488).
"In a multivariable analysis, we noted a 50% reduction in prostate cancer death [in those who were screened]. However, due to limited events, we did not reach statistical significance, though a trend was noted," Dr. Liss said.
The median age of PLCO participants was 62 years, and median follow-up was 12.6 years.
The findings are important, because the U.S. Preventive Services Task Force recently recommended against PSA screening, and although the AUA currently recommends screening, particularly for men at high risk, there currently are no clinical data to support this practice, he said.
These findings support the AUA position and suggest that screening men at high genetic risk may yield benefits in terms of prostate cancer mortality.
"We noted that patients with a family history only accounted for 7% of patients in the trial, indicating that there’s some bias in family history, and that possibly in the future, genetic variants could apply additional knowledge to people who are family history negative for prostate cancer," he said.
Dr. Liss reported having no financial disclosures.