Matikainen M P, Schleutker J, Mörsky P, Kallioniemi O P, Tammela T L
Laboratory of Cancer Genetics, Institute of Medical Technology, University of Tampere and Tampere University Hospital, Finland.
Clin Cancer Res. 1999 Jun;5(6):1275-9.
Positive family history is a significant risk factor for prostate cancer. Improved knowledge of the epidemiology and molecular basis of hereditary prostate cancer has led to a need for counseling and clinical follow-up for men with a positive family history of prostate cancer. However, very little information is available on the efficacy of early screening procedures, such as serum prostate-specific antigen (PSA) measurements, in the management of genetically predisposed, high-risk individuals. In a nationwide study, we obtained family histories from 2099 Finnish prostate cancer patients and identified 302 families with two or more affected cases. Here, 209 asymptomatic 45-75-year-old males from these families were included in a study to determine the frequency of serum PSA positivity and the prevalence of subclinical prostate cancers. Serum PSA was elevated in 21 (10.0%) of these high-risk individuals. Seven prostate cancers (3.3%) and two high-grade prostatic intraepithelial neoplasia lesions were diagnosed, with three cancers occurring in men ages < or = 59 years. Men from prostate cancer families with an average age of onset of < 60 years had a significantly higher frequency of PSA positivity (28.6%, P = 0.01) as well as cancers (14.3%, P = 0.02) than those with a later age of onset. The results suggest that prostate cancer development in genetically predisposed individuals is preceded by a subclinical period when PSA detection is possible. Serum PSA screening may be particularly useful in men with a family history of early-onset prostate cancer.
家族史阳性是前列腺癌的一个重要危险因素。对遗传性前列腺癌的流行病学和分子基础的认识不断提高，使得有前列腺癌家族史阳性的男性需要接受咨询和临床随访。然而，关于早期筛查程序（如血清前列腺特异性抗原（PSA）检测）在遗传易感性高风险个体管理中的效果，目前可用信息非常少。在一项全国性研究中，我们从2099名芬兰前列腺癌患者那里获取了家族史，并确定了302个有两例或更多患病病例的家庭。在此，来自这些家庭的209名无症状的45 - 75岁男性被纳入一项研究，以确定血清PSA阳性的频率和亚临床前列腺癌的患病率。这些高风险个体中有21人（10.0%）血清PSA升高。诊断出7例前列腺癌（3.3%）和2例高级别前列腺上皮内瘤变病变，其中3例癌症发生在年龄≤59岁的男性中。前列腺癌家族中平均发病年龄<60岁的男性，其PSA阳性频率（28.6%，P = 0.01）和癌症患病率（14.3%，P = 0.02）显著高于发病年龄较晚的男性。结果表明，在遗传易感性个体中，前列腺癌的发展在PSA检测可行的亚临床期之前。血清PSA筛查对有早发性前列腺癌家族史的男性可能特别有用。
