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Family history of prostate cancer and non-affected men's worry about genetic susceptibility
289 FAMILY HISTORY OF MEN’S WORRY ABOUT
PROSTATE GENETIC
CANCER AND SUSCEPTIBILITY
NON-AFFECTED
Cormier Luc’. Valeri Antoine’, Arzouzi Rhamenes, Moineau Marie-Pierre’, Berthon Philippe’. Cussenot Olivier’, Fournier Georges’. Guillemin Francis’, Mangin Philippe5 ‘Public Health School, Faculty of Medicine, Nancy, France, ZUrology, CHU Brest, Brest, France. ‘CeRePP, Paris VII University, Evry, France, “Nuclear Medical Laboratory, CHU Brest, Brest, France. SUrology. CHU Nancy. Nancy, France & OBJECTIVES: Worry about genetic susceptibility in first degree relatives (FDR) of men with prostate cancer (proband) may be an important stress factor. The aim of this study was to compare the level of worry about genetic susceptibility in FDR according to the family history of prostate cancer (Cap). INTRODUCTION
& METHODS: We contacted 375 eligible candidates for a screening procedure by PSA testing, non-affected sons or brothers of CaP patients (after proband’s agreement) and we asked them to fill out a survey with questions about sociodemographic characteristics, family history of CaP, and level of worry about CaP genetic susceptibility. This latter parameter was assessed with a five level Likert-type question from “not at all” to “extremely”. Data about the family history of CaP concerned genetic familial status. relationship with the proband and number of affected relatives. Genealogical analysis allowed to classify the individuals into hereditary (HR) status (3+CaP), familial without obvious hereditary pattern (FNH) (2CaP) or sporadic (S) (ICaP). The comparisons were assessed with an ANOVA procedure. MATERIALS
Of the 375 contacted candidates. 277 underwent PSA measurement and completed the questionnaire. Mean age was 52G. 21% of men did not worry at all about an inherited predisposition to CaP, 43% a little, 26% moderately, 7% a lot and 3% extremely. Familial status was FNH (35%), HR (21%) and S (44’%). 65% were sons of probands and 35% brothers. 44% had one relative CaP+ and 66% more than one. The number of affected relatives was associated with a higher level of worry (p=O.O3). Familial genetic status and relation with the proband did not appear significant.
RESULTS:
Worry about genetic susceptibility in at risk families for CaP is low but lightly increases when candidates have more than one affected relative. Other studies are needed to evaluate the clinical meaningful of such increase and the impact of worry on anxiety.
CONCLUSION:
290 PROSTATE CANCER HIGHER DETECTION FAMILIES WITHOUT
SCREENING IN HIGH RISK FAMILIES: IN FIRST DEGREE RELATIVES EVEN IN OBVIOUS HEREDITARY PATTERNS
Valeri A.. Cormier L., Moineau MP., Cancel-Tassin Cl., Azzouzi R., Joulin V.. Doucet L., Teillac P.. Berthon P., Mangin P., Cussenot O., Morin J., Foumier G. Urology Department
of Brest, Nancy, St. Louis; CeRePP, Evry, France
INTRODUCTION AND OBJECTIVES: Targeted screening in high risk families due to familial aggregation, is recommended as early as 40 years in first degree relatives (FDR) of CaP patients according to hish risk and early onset of the disease. We aimed to support its interest by demonstrating higher risk and earlier onset in these families. & METHODS: We performed a CaP screening by serum PSA testing, in a 3 years screening program, in 333 FDR (brothers or sons), 40-49 years old and 304 FDR 50-70 years old, of CaP patients treated, between 1994. 1997. A systematic genealogical analysis previously performed allowed to define the familial CaP status, at least I CaP in the family (range: 1-7): hereditary (HR) status (3+CaP; 9.9%), familial without obvious hereditary pattern (FNH) (2 CaP; 18.2%) or sporadic (S) (I CaP; 71.9%).
MATERIALS
RESULTS: Of the 333 men aged 40-49 (mean age: 44.5), for the first year assessment, 3 (0.9%) had a PSA level >4 ngiml (mean value 5.2 ngiml). Prostatic biopsies diagnosed CaP (pT2NOMO) in a 46 year old man, were negative in one relative (4.5 years old) and refused by the other (45 years old). Concerning the 304 men aged 50-70 (mean age 57.8). at first evaluation, 35 (1I .5%) had a PSA level >4 ng/ml: 13 CaP (4.2%) were diagnosed, 12 men had negative biopsies, 4 biopsies will be performed shortly and 6 candidates refused biopsies. Positive Predictive Value of high PSA was I3/25=52% which is a high value (I l-34% usually observed in unselected patients). Moreover, 9113 had sporadic status and 4113 diagnosed CaP belong to FNH families initially, displaying after the screening, 3 CaP (defining obvious hereditary status). This suggests that some families with only 2 CaP could be in fact hereditary CaP families and allows to identify new high risk individuals. In addition, CaP detection (8.3%) was high in men with early onset CaP in the family (~65 years) and 8113 CaP diagnosed belong to such families. Our results emphasise the utility of PSA screening in high risk families. including those families without obvious hereditary features. Those findings suggest, targeted screening in families with HR status but also with FNH status and in sporadic families with early onset (~65 years). CONCLUSION:
291 PSA LEVELS IN UNAFFECTED FIRST DEGREE PROSTATE CANCER PATIENTS ARE HIGHER WITHOUT FAMILY HISTORY OF THE DISEASE
RELATIVES THAN IN
OF MEN
Urology
Department
P.. Cusrenot
0.. Morin J., Fournier
PROSTATE
CANCER
KNOWLEDGE
Cormier Luc’, Reid Kristet?,
Valeri A.. Cormier L., Cancel-Tassin G., M. Giordanella, Kuntz M., Moineau MP.. Berthon P.. Mangin
292
G.
of Brest. Nancy, St. Louis; CeRePP. Evry, CNAM
France
INTRODUCTION AND OBJECTIVES: Family history (FH) is admitted to be an important risk factor for prostate cancer (Cap) and several studies have been conducted on screening in high risk families. However. few data are available concerning PSA levels in unaffected relatives in those families. We aimed to assess future prostate cancer risk in unaffected relatives by demonstrating higher PSA values
IN BROTHERS
AND
SONS
Kwan Lorna’, Liwin Mark’
‘Urology, UCLA, Los Angeles, United States of America, ‘DCPCR Jonsson Comprehensive Cancer Centre. UCLA, Los Angeles, United States of America, ‘Jonsson Comprehensive Centre, UCLA, Los Angeles, United States of America & OBJECTIVES: Prostate cancer knowledge is thought to predict screening behaviour in men with at least one first degree relative with prostate cancer but little is known about the extent of this knowledge. The aim of this study was to assess prostate cancer knowledge and identify associated sociodemographic factors.
INTRODUCTION
in high risk families. & METHODS: We contacted 837 men with a history of prostate cancer (probands) and invited them to ask their first-degree relatives (subjects) between 40-70 years old to participate in a study about screening behaviour. We explored prostate cancer knowledge in four domains with twenty questions: prostate anatomy and function, screening modalities and recommendations, risk factors. and prostate cancer warning signs. Age, marital relationship status, education. race. children, co-morbidity. urinary symptoms, employment status, number of relatives with prostate cancer and relationship to the proband were recorded. ANOVA and multivariate linear regression identified factors associated with better knowledge. MATERIALS
MATERIALS & METHODS: A CaP screening program (PSA testing) was conducted in 637 first degree relatives (FDR) (brothers or sons), 40-70 years old, of CaP patients in 3 French Urological centres. 92 of these 637 unaffected relatives were eligible for this present study: PSAd and 60-70 years old. A control population (consecutive men during the same period) was obtained from screening departments of French Public Health Centres: men without family history of CaP. 60-70 years old, and PSAs4. Subjects and controls were divided into 2 subgroups: i.c. ages 60.63 and 65-70. An ANOVA procedure was performed to compare PSA level in each group. RESULTS: For each age group. mean PSA levels were significantly higher in individuals with positive FH than in controls (table). Moreover the age-adjusted PSA level was significantly higher in FH+ men than in controls: I.71 ngiml YF. 1.26 respectively (p=O.O004). In addition the rate of FH+ subjects with PSA in the range 2.5-4 ng/mI was higher 14% vs. 5.1% (although non significant) in the 60.64 years
old group and 28.6% vs. 10.3% (p=O.O07) in the 65-70 years old group. Age 60-64 y, n Mean Mean 65-70 y, n Mean Mean
PSA Age PSA Age
FH+ men SO I .65iO.83 62kl.4 42 1.71+1.02 j 67.4+1.6
1
Controls 39 I .22+00.7 I 62.3&l .J 97 I.3 I ?t).XX 68.7kl.7
p 0.01
0.02
1
CONCLUSION: Those preliminary results show that unaffected men with FH of CaP have higher PSA levels than controls. This supports additional evidence that FDR of CaP patients are high risk individuals for this disease.
RESULTS: Among the 139 of I55 (90%) subjects who returned the questionnaire, mean age was 53,92% were white, 81% had children, 71% were college graduates, 80% were employed, 27% had more than one relative with prostate cancer, 43% had their father as proband, mean IPSS score was 5, and 60% of men declared no co-morbidity. 71% of subjects correctly answered at least half of the questions about prostate function, 98% about screening recommendations, 85% about risk factors and 55% about warning signs. Higher income, lower age, higher education level, no co-morbidity and no children were associated with better knowledge. These factors explained 3 to 18% of the variance.
Subjects’ prostate cancer knowledge appeared relatively high, with the exception of warning signs. Doctors could customise screening message delivered to men at risk for prostate cancer by noting socioeconomic difference\ in their patients. CONCLUSION:
European
Urology
Supplements
1 (2002) No. 1, pp. 75
PROSTATE GENETIC
CANCER AND SUSCEPTIBILITY
NON-AFFECTED
Cormier Luc’. Valeri Antoine’, Arzouzi Rhamenes, Moineau Marie-Pierre’, Berthon Philippe’. Cussenot Olivier’, Fournier Georges’. Guillemin Francis’, Mangin Philippe5 ‘Public Health School, Faculty of Medicine, Nancy, France, ZUrology, CHU Brest, Brest, France. ‘CeRePP, Paris VII University, Evry, France, “Nuclear Medical Laboratory, CHU Brest, Brest, France. SUrology. CHU Nancy. Nancy, France & OBJECTIVES: Worry about genetic susceptibility in first degree relatives (FDR) of men with prostate cancer (proband) may be an important stress factor. The aim of this study was to compare the level of worry about genetic susceptibility in FDR according to the family history of prostate cancer (Cap). INTRODUCTION
& METHODS: We contacted 375 eligible candidates for a screening procedure by PSA testing, non-affected sons or brothers of CaP patients (after proband’s agreement) and we asked them to fill out a survey with questions about sociodemographic characteristics, family history of CaP, and level of worry about CaP genetic susceptibility. This latter parameter was assessed with a five level Likert-type question from “not at all” to “extremely”. Data about the family history of CaP concerned genetic familial status. relationship with the proband and number of affected relatives. Genealogical analysis allowed to classify the individuals into hereditary (HR) status (3+CaP), familial without obvious hereditary pattern (FNH) (2CaP) or sporadic (S) (ICaP). The comparisons were assessed with an ANOVA procedure. MATERIALS
Of the 375 contacted candidates. 277 underwent PSA measurement and completed the questionnaire. Mean age was 52G. 21% of men did not worry at all about an inherited predisposition to CaP, 43% a little, 26% moderately, 7% a lot and 3% extremely. Familial status was FNH (35%), HR (21%) and S (44’%). 65% were sons of probands and 35% brothers. 44% had one relative CaP+ and 66% more than one. The number of affected relatives was associated with a higher level of worry (p=O.O3). Familial genetic status and relation with the proband did not appear significant.
RESULTS:
Worry about genetic susceptibility in at risk families for CaP is low but lightly increases when candidates have more than one affected relative. Other studies are needed to evaluate the clinical meaningful of such increase and the impact of worry on anxiety.
CONCLUSION:
290 PROSTATE CANCER HIGHER DETECTION FAMILIES WITHOUT
SCREENING IN HIGH RISK FAMILIES: IN FIRST DEGREE RELATIVES EVEN IN OBVIOUS HEREDITARY PATTERNS
Valeri A.. Cormier L., Moineau MP., Cancel-Tassin Cl., Azzouzi R., Joulin V.. Doucet L., Teillac P.. Berthon P., Mangin P., Cussenot O., Morin J., Foumier G. Urology Department
of Brest, Nancy, St. Louis; CeRePP, Evry, France
INTRODUCTION AND OBJECTIVES: Targeted screening in high risk families due to familial aggregation, is recommended as early as 40 years in first degree relatives (FDR) of CaP patients according to hish risk and early onset of the disease. We aimed to support its interest by demonstrating higher risk and earlier onset in these families. & METHODS: We performed a CaP screening by serum PSA testing, in a 3 years screening program, in 333 FDR (brothers or sons), 40-49 years old and 304 FDR 50-70 years old, of CaP patients treated, between 1994. 1997. A systematic genealogical analysis previously performed allowed to define the familial CaP status, at least I CaP in the family (range: 1-7): hereditary (HR) status (3+CaP; 9.9%), familial without obvious hereditary pattern (FNH) (2 CaP; 18.2%) or sporadic (S) (I CaP; 71.9%).
MATERIALS
RESULTS: Of the 333 men aged 40-49 (mean age: 44.5), for the first year assessment, 3 (0.9%) had a PSA level >4 ngiml (mean value 5.2 ngiml). Prostatic biopsies diagnosed CaP (pT2NOMO) in a 46 year old man, were negative in one relative (4.5 years old) and refused by the other (45 years old). Concerning the 304 men aged 50-70 (mean age 57.8). at first evaluation, 35 (1I .5%) had a PSA level >4 ng/ml: 13 CaP (4.2%) were diagnosed, 12 men had negative biopsies, 4 biopsies will be performed shortly and 6 candidates refused biopsies. Positive Predictive Value of high PSA was I3/25=52% which is a high value (I l-34% usually observed in unselected patients). Moreover, 9113 had sporadic status and 4113 diagnosed CaP belong to FNH families initially, displaying after the screening, 3 CaP (defining obvious hereditary status). This suggests that some families with only 2 CaP could be in fact hereditary CaP families and allows to identify new high risk individuals. In addition, CaP detection (8.3%) was high in men with early onset CaP in the family (~65 years) and 8113 CaP diagnosed belong to such families. Our results emphasise the utility of PSA screening in high risk families. including those families without obvious hereditary features. Those findings suggest, targeted screening in families with HR status but also with FNH status and in sporadic families with early onset (~65 years). CONCLUSION:
291 PSA LEVELS IN UNAFFECTED FIRST DEGREE PROSTATE CANCER PATIENTS ARE HIGHER WITHOUT FAMILY HISTORY OF THE DISEASE
RELATIVES THAN IN
OF MEN
Urology
Department
P.. Cusrenot
0.. Morin J., Fournier
PROSTATE
CANCER
KNOWLEDGE
Cormier Luc’, Reid Kristet?,
Valeri A.. Cormier L., Cancel-Tassin G., M. Giordanella, Kuntz M., Moineau MP.. Berthon P.. Mangin
292
G.
of Brest. Nancy, St. Louis; CeRePP. Evry, CNAM
France
INTRODUCTION AND OBJECTIVES: Family history (FH) is admitted to be an important risk factor for prostate cancer (Cap) and several studies have been conducted on screening in high risk families. However. few data are available concerning PSA levels in unaffected relatives in those families. We aimed to assess future prostate cancer risk in unaffected relatives by demonstrating higher PSA values
IN BROTHERS
AND
SONS
Kwan Lorna’, Liwin Mark’
‘Urology, UCLA, Los Angeles, United States of America, ‘DCPCR Jonsson Comprehensive Cancer Centre. UCLA, Los Angeles, United States of America, ‘Jonsson Comprehensive Centre, UCLA, Los Angeles, United States of America & OBJECTIVES: Prostate cancer knowledge is thought to predict screening behaviour in men with at least one first degree relative with prostate cancer but little is known about the extent of this knowledge. The aim of this study was to assess prostate cancer knowledge and identify associated sociodemographic factors.
INTRODUCTION
in high risk families. & METHODS: We contacted 837 men with a history of prostate cancer (probands) and invited them to ask their first-degree relatives (subjects) between 40-70 years old to participate in a study about screening behaviour. We explored prostate cancer knowledge in four domains with twenty questions: prostate anatomy and function, screening modalities and recommendations, risk factors. and prostate cancer warning signs. Age, marital relationship status, education. race. children, co-morbidity. urinary symptoms, employment status, number of relatives with prostate cancer and relationship to the proband were recorded. ANOVA and multivariate linear regression identified factors associated with better knowledge. MATERIALS
MATERIALS & METHODS: A CaP screening program (PSA testing) was conducted in 637 first degree relatives (FDR) (brothers or sons), 40-70 years old, of CaP patients in 3 French Urological centres. 92 of these 637 unaffected relatives were eligible for this present study: PSAd and 60-70 years old. A control population (consecutive men during the same period) was obtained from screening departments of French Public Health Centres: men without family history of CaP. 60-70 years old, and PSAs4. Subjects and controls were divided into 2 subgroups: i.c. ages 60.63 and 65-70. An ANOVA procedure was performed to compare PSA level in each group. RESULTS: For each age group. mean PSA levels were significantly higher in individuals with positive FH than in controls (table). Moreover the age-adjusted PSA level was significantly higher in FH+ men than in controls: I.71 ngiml YF. 1.26 respectively (p=O.O004). In addition the rate of FH+ subjects with PSA in the range 2.5-4 ng/mI was higher 14% vs. 5.1% (although non significant) in the 60.64 years
old group and 28.6% vs. 10.3% (p=O.O07) in the 65-70 years old group. Age 60-64 y, n Mean Mean 65-70 y, n Mean Mean
PSA Age PSA Age
FH+ men SO I .65iO.83 62kl.4 42 1.71+1.02 j 67.4+1.6
1
Controls 39 I .22+00.7 I 62.3&l .J 97 I.3 I ?t).XX 68.7kl.7
p 0.01
0.02
1
CONCLUSION: Those preliminary results show that unaffected men with FH of CaP have higher PSA levels than controls. This supports additional evidence that FDR of CaP patients are high risk individuals for this disease.
RESULTS: Among the 139 of I55 (90%) subjects who returned the questionnaire, mean age was 53,92% were white, 81% had children, 71% were college graduates, 80% were employed, 27% had more than one relative with prostate cancer, 43% had their father as proband, mean IPSS score was 5, and 60% of men declared no co-morbidity. 71% of subjects correctly answered at least half of the questions about prostate function, 98% about screening recommendations, 85% about risk factors and 55% about warning signs. Higher income, lower age, higher education level, no co-morbidity and no children were associated with better knowledge. These factors explained 3 to 18% of the variance.
Subjects’ prostate cancer knowledge appeared relatively high, with the exception of warning signs. Doctors could customise screening message delivered to men at risk for prostate cancer by noting socioeconomic difference\ in their patients. CONCLUSION:
European
Urology
Supplements
1 (2002) No. 1, pp. 75