Department of Urology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
Department of Mathematics and Life Sciences, Technical University of Munich, Munich, Germany.
World J Urol. 2021 Jul;39(7):2499-2506. doi: 10.1007/s00345-020-03485-5. Epub 2020 Oct 13.
To assess whether a first-degree family history or a fatal family history of prostate cancer (PCa) are associated with postoperative upgrading and upstaging among men with low risk and favourable intermediate-risk (FIR) PCa and to provide guidance on clinical decision making for active surveillance (AS) in this patient population.
Participants in the German Familial Prostate Cancer database diagnosed from 1994 to 2019 with (1) low risk (clinical T1c-T2a, biopsy Gleason Grade Group (GGG) 1, PSA < 10 ng/ml), (2) Gleason 6 FIR (clinical T1c-T2a, GGG 1, PSA 10-20 ng/ml), and (3) Gleason 3 + 4 FIR (clinical T1c-T2a, GGG 2, PSA < 10 ng/ml) PCa who were subsequently treated with radical prostatectomy (RP) were analysed for upgrading, defined as postoperative GGG 3 tumour or upstaging, defined as pT3-pT4 or pN1 disease at RP. Logistic regression analysis was used to assess whether PCa family history was associated with postoperative upgrading or upstaging.
Among 4091 men who underwent RP, mean age at surgery was 64.4 (SD 6.7) years, 24.7% reported a family history, and 3.4% a fatal family history. Neither family history nor fatal family history were associated with upgrading or upstaging at low risk, Gleason 6 FIR, and Gleason 3 + 4 FIR PCa patients.
Results from the current study indicated no detrimental effect of family history on postoperative upgrading or upstaging. Therefore, a positive family history or fatal family history of PCa in FIR PCa patients should not be a reason to refrain from AS in men otherwise suitable.
评估一级亲属或致命家族史是否与低危和有利中危（FIR）前列腺癌（PCa）患者的术后升级和分期有关，并为该患者人群的主动监测（AS）提供临床决策指导。
从 1994 年至 2019 年，德国家族性前列腺癌数据库中的参与者被诊断为（1）低危（临床 T1c-T2a，活检 Gleason 分级组（GGG）1，PSA<10ng/ml），（2）Gleason 6 FIR（临床 T1c-T2a，GGG 1，PSA 10-20ng/ml）和（3）Gleason 3+4 FIR（临床 T1c-T2a，GGG 2，PSA<10ng/ml）PCa，随后接受根治性前列腺切除术（RP）治疗，分析术后升级，定义为术后 GGG 3 肿瘤，或分期升级，定义为 RP 时 pT3-pT4 或 pN1 疾病。Logistic 回归分析用于评估 PCa 家族史是否与术后升级或分期有关。
在 4091 名接受 RP 的男性中，手术时的平均年龄为 64.4（SD 6.7）岁，24.7%报告有家族史，3.4%有致命家族史。家族史或致命家族史均与低危、Gleason 6 FIR 和 Gleason 3+4 FIR PCa 患者的术后升级或分期无关。
本研究结果表明家族史对术后升级或分期无不利影响。因此，FIR PCa 患者的阳性家族史或致命家族史不应成为不适合男性 AS 的理由。
