McLellan D L, Norman R W
Dalhousie University, Halifax, NS.
CMAJ. 1995 Oct 1;153(7):895-900.
To review current literature on the hereditary aspects of prostate cancer and to evaluate the importance of family history in history taking and screening for prostate cancer.
MEDLINE was searched for articles in English or French published between Jan. 1, 1956, and Oct. 31, 1994, with the use of MeSH headings "prostatic neoplasms," "genetics" and "chromosomes." Additional references were selected from the bibliographies of articles found during the search.
Case-control studies involving the incidence of prostate cancer and relative risk (RR) of such cancer in the families of men with this disease, compared with a control group, were included. Only studies in which prostate cancer was diagnosed on the basis of histologic tests were included. Animal investigations were excluded.
Ten case-control studies were evaluated critically in terms of design, case and control groups, the size of the samples and statistical results. The incidence of prostate cancer in the families of cases, compared with that in the families of controls, and differences in RR were reviewed.
The lifetime risk of prostate cancer is 9.5% and of death from prostate cancer is 2.9% for a man 50 years of age. For first-degree male relatives of men with prostate cancer, the calculated RR ranges from 1.7 to 8.73. "Hereditary" prostate cancer is a term applied to a specific subset of patients with prostate cancer. This form of prostate cancer is transmitted by a rare, autosomal, dominant allele with high penetrance; it accounts for an estimated 43% of early-onset disease (affecting men less than 55 years of age) but only 9% of all prostate cancer in men up to 85 years of age. A greater number of affected family members and early onset among family members are the most significant predictors of risk.
Recent confirmation of the familial clustering and Mendelian inheritance patterns of some prostate cancer has important implications. It increases the potential for directed research into the causes of prostate cancer and for refinements in the current screening practices to detect this common disease. Manoeuvres to detect prostate cancer should be started earlier among men with one or more first-degree relatives with the disease than among other men.
回顾关于前列腺癌遗传因素的现有文献，并评估家族史在前列腺癌病史采集和筛查中的重要性。
利用医学主题词“前列腺肿瘤”“遗传学”和“染色体”，检索1956年1月1日至1994年10月31日期间发表的英文或法文文章。从检索到的文章参考文献中选取其他参考文献。
纳入病例对照研究，该研究涉及前列腺癌的发病率以及患此病男性家族中患该癌症的相对风险（RR），并与对照组进行比较。仅纳入基于组织学检查诊断前列腺癌的研究。排除动物研究。
从设计、病例组和对照组、样本量及统计结果等方面对10项病例对照研究进行严格评估。比较病例组家族和对照组家族中前列腺癌的发病率以及RR的差异。
50岁男性患前列腺癌的终生风险为9.5%，死于前列腺癌的风险为2.9%。对于前列腺癌男性患者的一级男性亲属，计算出的RR范围为1.7至8.73。“遗传性”前列腺癌是用于特定前列腺癌患者亚组的术语。这种形式的前列腺癌由一种罕见的、常染色体显性高 penetrance 等位基因传递；估计占早发性疾病（影响年龄小于55岁的男性）的43%，但在85岁以下男性的所有前列腺癌中仅占9%。受影响家庭成员数量较多以及家庭成员发病较早是风险的最重要预测因素。
近期对部分前列腺癌家族聚集性和孟德尔遗传模式的证实具有重要意义。这增加了针对前列腺癌病因进行定向研究以及改进当前筛查方法以检测这种常见疾病的可能性。对于有一个或多个患此病一级亲属的男性，应比其他男性更早开始进行前列腺癌检测措施。
