Family history of prostate cancer and prostate tumor aggressiveness in black and non-black men;results from an equal access biopsy study

Abstract

Purpose To test for racial differences in associations between family history (FH) of prostate cancer (PC) and prostate cancer aggressiveness in a racially diverse equal access population undergoing prostate biopsy. Subjects/patients and methods We prospectively enrolled men undergoing prostate biopsy at the Durham Veterans Administration from 2007 to 2018 and assigned case or control status based on biopsy results. Race and FH of PC were self-reported on questionnaires. Logistic regression was used to test the association between FH and PC diagnosis overall and by tumor aggressiveness [high- (Grade Group 3–5) or low-grade (Grade Group 1–2) vs. no cancer], overall, and stratified by race. Models were adjusted for age and year of consent, race, PSA level, digital rectal exam findings, prostate volume, and previous (negative) biopsy receipt. Results Of 1,225 men, 323 had a FH of PC and 652 men were diagnosed with PC on biopsy. On multivariable analysis, FH was associated with increased odds of high-grade PC in black (OR 1.85, p = 0.041) and all men (OR 1.56, p = 0.057) and was unrelated to overall or low-grade PC diagnosis, overall, or stratified by race (all p ≥ 0.325). In sensitivity analyses among men without a previous biopsy, results were slightly more pronounced. Conclusion In this setting of equal access to care, positive FH of PC was associated with increased tumor aggressiveness in black men, but not non-black men undergoing prostate biopsy. Further research is required to tease apart the contribution of genetics from increased PC awareness potentially influencing screening and biopsy rates in men with FH.

An In-Depth Look Into the Epidemiological and Etiological Aspects of Prostate Cancer: A Literature Review

“…However, it's crucial to highlight that this racial distinction did not reach statistical significance, and there was no observable interaction between family history of prostate cancer and race in predicting the probability of high-grade prostate cancer. Furthermore, the lack of information about a family history of prostate cancer did not yield any association with prostate cancer, whether it was of low or high grade, in the entire cohort, or when examined within different racial groups [ 27 ].…”

Evaluation of HNF1B, KLK3, ELAC2, TMPRSS2‐ERG, and CTNNB1 polymorphisms associated with prostate cancer in samples of patients from HUPE‐UERJ

“…However, most population studies investigating the relationship between family history and Pca have primarily involved men from white populations, and it is uncertain if the results apply to the black population, as highlighted by Jenkins et al in 2021. 4 It is worth noting that oncogenes, which are associated with a poorer clinical prognosis, 5 may be more prevalent in certain ethnic and racial groups. [6][7][8][9] Thus, the rare allele present may be a genetic signature of a particular population.…”

“…A family history of Pca is linked to an increased risk of high‐grade disease, particularly in black men, who are more likely to be diagnosed with a more aggressive form of the disease on biopsy than non‐Black men. However, most population studies investigating the relationship between family history and Pca have primarily involved men from white populations, and it is uncertain if the results apply to the black population, as highlighted by Jenkins et al in 2021 4 …”

The role of genetic testing in prostate cancer screening, diagnosis, and treatment

“…These differences are in large part because of socioeconomic inequalities and unequal access and receipt of care, but studies have shown that after attempting to control for these factors, a disparity persists, suggesting that biologic factors are also implicated [19,20]. A recent prospective study suggested that African American men might benefit from earlier screening or more aggressive screening protocols, especially if the family history is positive [21]. But overall, most studies evaluating family history have been mainly constituted of Caucasian men, so less is known about the impact of a positive family history in African American men.…”