Introduction and Objectives
Prostate cancer (PrCa) is the most common malignancy in men in many industrialized countries and positive family history of the disease is one of the strongest known risk factors of this disease. However, clinical features of familial PrCa are still poorly known. Families with PrCa have been collected in Finland since 1995. The aim of this study was to describe clinical characteristics of PrCas in the Finnish PrCa families using detailed analysis of patient records and histopathological samples.
Material and Methods
202 Finnish families with 617 PrCa cases with confirmed histology and genealogy was collected. The mean number of affected men per family was 3.1. Complete clinical data including age and PSA at diagnosis, stage, grade and primary treatment was collected from hospital records. All the diagnostic biopsy samples, which were available (n = 323) were collected, reviewed and re-graded by the same experienced uropathologist.
The mean year of diagnosis was 1993 (range 1962–2006) and the mean age at diagnosis was 68 (range 43–98). The median value of primary PSA was 16 (range 0.8–11000). In clinical staging 49% had local T1–2 disease, 39 % advanced, stage T3–4 disease and 17% of the patients had metastases at the time of diagnosis. In original histological grading 11% of the PrCa cases had WHO III, 56% had WHO II and 33% WHO I. After re-grading the grade distribution was: 22% WHO III, 65% WHO II and 13% WHO I. In original Gleason grading (available of 204, 63% of the samples) the distribution was 72% of Gleason score under 7, 18 % of Gleason score 7 and 11 % of Gleason score over 7. And after re-evaluation 38% of Gleason score under 7, 37% of Gleason score 7 and 25% of Gleason score over 7, respectively. The changes were statistically significant (p = 0.0015 in WHO grading and p = 6.9 × 10−8 in Gleason grading). The most common primary treatments were surgical castration (27%), radical prostatectomy (24%), chemical castration (11%) and radiation therapy (10%).
Familial PrCa has an slightly earlier age of onset than the mean age of diagnosis of PrCa in Finland. However, the criteria for Gleason grading has changed remarkably during the 14 years of collection. Therefore, preferably re-evaluation and re-grading by the experienced uropathologist is needed when comparing pathological grading of tumours from a long time period.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.