Family History of Invasive Prostate Cancer and PBSIN Should Be Important Part of Screening

Family history of prostatic borderline or in situ neoplasia (PBSIN) appears to be as important as invasive prostate cancer (PCa) in the increased risk of disease or death. This history should be an essential part of screening recommendations for prostate cancer and a part of research, according to research published in Cancer.

Looking at the Nationwide Swedish family cancer data set, researchers looked at 6,343,727 men where a total of 238,961 patients developed invasive PCa and 5,756 men were diagnosed with PBSIN in the follow up. The men with a first-degree relative (FDR) who were diagnosed with PBSIN had a 70% increased risk of invasive PCa diagnosis and death compared to men without a family history of PCa and PBSIN. Moreover, for patients with a family history of PBSIN and invasive PCa diagnosed before age 60 there was a higher risk of being diagnosed with PCa. A total of 1,165 patients diagnosed first also had PBSIN, which was found to have later developed into invasive PCa, accounting for 17% of patients with PBSIN in the study.

“Men with a family history of invasive PCa have been reported to be at an increased risk of dying of PCa. We observed that men with 1 FDR diagnosed with PBISN also were at an increased risk of dying of PCa, similar to men with a history of invasive PCa in 1 FDR,” explained the authors. “This finding demonstrated that the scope of risk associated with a family history of PBISN is not limited to developing PCa, but extends to death due to PCa, which is a more definitive outcome.”

The risk of invasive PCa for men with 1 FDR diagnosed with invasive PCA increased two-fold, according to the research. Relative risk estimates increased depending on the relationship with the patient. For example, men with a father affected by PBISN had their risk of developing invasive PCa increased by approximately 80%. Men with an affected brother had their risk of invasive PCa increase by 70%. Cumulative lifetime risk for developing invasive PCa for men with one FDR affected by PBSIN was 24% double that of men without any family history of PCa (12%).

“The similarity of results using invasive PCa as the primary outcome and those with death due to PCa as a confirmatory secondary outcome ensured that the current study findings did not primarily reflect the overdiagnosis of indolent PCa due to more screening taking place among family members of patients with prostate tumors,” the researchers explained.

PBSIN is a marker for both borderline prostate and carcinoma in situ. When referring to borderline prostate this is the levels of prostate specific antigen that measures if patients have cancer in their prostate or a carcinoma in situ, a group of abnormal cells that remain where they first formed. This would indicate the potential for cancer in the prostate and researchers argue that understanding this history and screening for it should be a regular part of screening guidelines.

“The results of the current study have provided novel evidence‐based information for clinicians and for the relatives of men who have been diagnosed with PBISN,” researchers concluded. “Having a family history of PBISN was found to be associated with an increased risk of invasive PCa and death from PCa on a magnitude close to that for having a family history of invasive PCa.”

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