The objective of this study was to evaluate potential sociodemographic, medical, psychosocial, and behavioral correlates of interest in genetic testing in men from hereditary prostate cancer families (HPC).
Family members affected with prostate cancer (n=559) and their unaffected male relatives (n=370) completed a mailed survey. Multivariable logistic regression models were used to examine the association between potential correlates and interest in genetic testing for prostate cancer.
Forty-five percent of affected and 56% of unaffected men reported that they definitely would take a genetic test for prostate cancer. More affected men reported high levels of familiarity with genetic testing than unaffected men (46% vs. 25%). There were several variables that were significantly correlated with interest in either affected or unaffected men but only age and familiarity with genetics were significant in both groups. After controlling for confounding variables, only familiarity remained a significant correlate in both groups.
The contrast between low levels of familiarity with genetics and high test interest among unaffected men highlights the need for increased educational efforts targeting HPC families. Overall, results illuminated several novel characteristics of men from HPC families that should be considered when developing future informed consent procedures or educational materials for prostate cancer genetic testing.
Prostate cancer; family; hereditary; genetic test; psychosocial
Prostate cancer is the proliferation of malignant cells in the prostate gland. The HPC2/ELAC2 gene on chromosome 17p11.2 and SRD5A2 gene on chromosome 2p22–23 are predisposing genetic factors. We examined the relationship between Ser217Leu and Ala541Thr polymorphisms of the former gene, and Ala49Thr and Val89Leu polymorphisms of the latter gene to prostate cancer in Turkish men, using the polymerase chain reaction (PCR) method and appropriate restriction enzymes. The HPC2/ELAC2 gene Ser217-Leu and SRD5A2 gene Ala49Thr polymorphisms were associated with an increased risk of prostate cancer in Turkish men [for the HPC2/ELAC2 gene Ser217Leu polymorphism: odds ratio (OR) 2.7; confidence interval 95% (CI 95%) 1.6–4.8; p 0.000<0.05, and for the SRD5A2 gene Ala49Thr polymorphism: OR 2.4; CI 95% 1.2–4.9; p 0.004<0.05].
Prostate cancer; HPC2/ELAC2 gene; SRD5A2 gene; Polymorphism
Multiple prostate cancer (PCa) risk-related loci have been discovered by genome-wide association studies (GWAS) based on case–control designs. However, GWAS findings may be confounded by population stratification if cases and controls are inadvertently drawn from different genetic backgrounds. In addition, since these loci were identified in cases with predominantly sporadic disease, little is known about their relationships with hereditary prostate cancer (HPC). The association between seventeen reported PCa susceptibility loci was evaluated with a family-based association test using 1,979 hereditary PCa families of European descent collected by members of the International Consortium for Prostate Cancer Genetics, with a total of 5,730 affected men. The risk alleles for 8 of the 17 loci were significantly over-transmitted from parents to affected offspring, including SNPs residing in 8q24 (regions 1, 2 and 3), 10q11, 11q13, 17q12 (region 1), 17q24 and Xp11. In subgroup analyses, three loci, at 8q24 (regions 1 and 2) plus 17q12, were significantly over-transmitted in hereditary PCa families with five or more affected members, while loci at 3p12, 8q24 (region 2), 11q13, 17q12 (region 1), 17q24 and Xp11 were significantly over-transmitted in HPC families with an average age of diagnosis at 65 years or less. Our results indicate that at least a subset of PCa risk-related loci identified by case–control GWAS are also associated with disease risk in HPC families.
One barrier to genetic testing is the lack of access to genetic counselors. We provided cancer genetic counseling via telephone, through a pilot project for employees of a national health insurer, Aetna, Inc. Knowledge transfer, behavioral intentions, and patient satisfaction were assessed by survey after genetic counseling. Aetna sent an individual email to its employees nationwide notifying them of the availability of a new telephone genetic counseling and testing program and providing a link to take a brief screening questionnaire to determine whether they may be at risk of hereditary cancer. Employees completing the questionnaire received immediate feedback regarding whether there appeared to be a risk of hereditary cancer. If so, they were invited to schedule a telephonic genetic counseling session. After the session, respondents completed an online survey. 397 individuals completed the questionnaire. 39 proceeded with telephone genetic counseling, and 22 completed the follow-up survey, including all 11 women with family history warranting genetic testing. One third reported prior discussion about inherited cancer risk with their primary care provider (PCP); 12% were referred to a geneticist; 20% had an accurate perception of their own cancer risk. After counseling, 94% reported understanding their risk for cancer and 87% were aware of available risk-reduction strategies. 87% of high-risk respondents intended to engage in risk-management interventions. 93% reported high satisfaction. 66% indicated they would not have pursued genetic counseling if it had not been available by phone. Results suggest telephone counseling is a viable option for increasing access to genetic experts. In this sample, telephone counseling increases knowledge of cancer risk, motivates intention to change health-related behaviors, and elicits a high satisfaction level. Consequently, Aetna now offers telephone cancer genetic counseling nationwide as a covered benefit.
BRCA 1/2; Cancer genetic counseling; Cancer risk assessment; Genetic testing; Hereditary cancer; Telephone genetic counseling
Much of the research examining psychosocial aspects of genetic testing has used hypothetical scenarios, based on the largely untested assumption that hypothetical genetic testing intentions are good proxies for behavior. We tested whether hypothetical interest predicts uptake of genetic testing and whether factors that predict interest also predict uptake.
Participants (n = 116) were smokers and related to patients with lung cancer, who completed a telephone survey. Interest in genetic testing for lung cancer risk was indicated by responding ‘definitely would’ to a Likert-style question. Internet-delivered genetic testing for lung cancer risk was then offered. Uptake was indicated by requesting the test and receiving the result.
63% of participants said they ‘definitely would’ take the genetic test; uptake was 38%. Participants who said they ‘definitely would’ take the test were more likely than others to take the offered test (45% vs. 26%, p = 0.035). Interest was associated with attitudes towards genetic testing and motivation to quit smoking. Uptake was associated with motivation, prior awareness of genetic testing, and daily Internet use.
Hypothetical interest only modestly predicts uptake of genetic testing. Interest in genetic testing likely reflects generally positive attitudes that are not good predictors of the choices individuals subsequently make.
Attitudes; Complex diseases; Decision-making; Evaluation of genetic/genomic tools for public health; Genetic testing; Interest; Lung cancer; Uptake
The National Health Service Prostate Cancer Risk Management Programme (PCRMP) has recommended that screening for prostate cancer is available for asymptomatic men, on the understanding that they have been provided with full and balanced information about the advantages and limitations of the prostate-specific antigen (PSA) test. Guidance has been distributed to all GPs in England and Wales to assist in the provision of information to men. This study aimed to elicit GPs' accounts of their discussions with asymptomatic men who consult with concerns about prostate cancer in order to identify the degree to which the PCRMP guidance was reflected in these consultations.
Qualitative interview study. Semi-structured telephone interviews with 21 GPs from 18 GP practices in Oxfordshire.
All GPs reported undertaking some discussion with asymptomatic men about the PSA test. They described focussing most of the discussion on the false-positive and false-negative rates of the test, and the risks associated with a prostate biopsy. They reported less discussion of the potential for diagnosing indolent cancers, the dilemmas regarding treatment options for localised prostate cancer and the potential benefits of testing. Considerable variation existed between GPs in their accounts of the degree of detail given, and GP's presentation of information appeared to be affected by their personal views of the PSA test.
The GPs in this study appear to recognise the importance of discussions regarding PSA testing; however, a full and balanced picture of the associated advantages and limitations does not seem to be consistently conveyed. Factors specific to PSA testing which appeared to have an impact on the GPs' discussions were the GP's personal opinions of the PSA test, and the need to counter men's primarily positive views of the benefits of PSA testing. Awareness of the impact of their views on the consultations may help GPs give men a more balanced presentation of the benefits and limitations of the PSA test.
A genome-wide scan of high-risk prostate cancer families in North America has demonstrated linkage of a particular marker to Chromosome 1q (HPC1). An even greater proportion of African-American families have shown linkage to HPC1. Therefore, investigators at the National Human Genome Research Institute (NHGRI) in collaboration with Howard University and a predominantly African-American group of urologists established the African-American Hereditary Prostate Cancer (AAHPC) Study Network to confirm the suggested linkage of HPC in African Americans with a gene on Chromosome 1. Blood samples from recruited families were sent to Howard University for extraction of DNA. The DNA was sent to NHGRI at NIH where the genotyping and genetic sequence analysis was conducted. Genotype data are merged with pedigree information so that statistical analysis can be performed to establish potential linkage. From March 1, 1998, to June 1, 1999, a total of 40 African-American families have been recruited who met the study criteria. Preliminary results suggest that racial/ethnicity grouping may affect the incidence and extent of linkage of prostate cancer to specific loci. The importance of these findings lays in the future treatment of genetic-based diseases.
A genome-wide scan of high-risk prostate cancer families in North America has demonstrated linkage of a particular marker to Chromosome Iq (HPC11. An even greater proportion of African-American families have shown linkage to HPC 1. Therefore, investigators at the National Human Genome Research Institute [NHGRI] in collaboration with Howard University and a predominantly African-American group of urologists established the African-American Hereditary Prostate Cancer (AAHPC) Study Network to confirm the suggested linkage of HPC in African Americans with a gene on Chromosome 1. Blood samples from recruited families were sent to Howard University for extraction of DNA. The DNA was sent to NHGRI at NIH where the genotyping and genetic sequence analysis was conducted. Genotype data are merged with pedigree information so that statistical analysis can be performed to establish potential linkage. From March 1, 1998, to June 1, 1999, a total of 40 African-American families have been recruited who met the study criteria. Preliminary results suggest that racial/ethnicity grouping may affect the incidence and extent of linkage of prostate cancer to specific loci. The importance of these findings lays in the future treatment of genetic-based diseases.
Differences in prostate-specific antigen (PSA) awareness may contribute to differences in frequency of PSA testing. We investigated the association of health risk behaviors, including smoking, physical inactivity, obesity, and excessive alcohol consumption with awareness of the PSA test among California men at risk for prostate cancer.
Materials and Methods
Using California Health Interview Survey (CHIS) 2003 data, a population-based random-digit-dial telephone survey, records of 7,297 men aged 50 years and older without a prior history of prostate cancer were identified. The outcome was self-reported awareness of the PSA test. The main independent variables were smoking status, level of physical activity, body mass index (BMI), and alcohol consumption. Prevalence, odds ratios (OR) and 95% confidence intervals (CI) for PSA awareness were calculated using SUDAAN to account for the complex sampling design.
The overall prevalence of PSA awareness was 73.0%. After controlling for potential confounders, the odds of being aware of the PSA test was lower among current smokers (OR= 0.53; 95% CI =0.41-0.68 vs. never smoked), physically inactive (OR=0.77; 95% CI=0.63-0.93 vs. physically active) and obese men (OR=0.77; 95% CI= 0.62-0.95 vs. normal weight).
Health risk behaviors are associated with lower PSA awareness. Our findings suggest opportunities for focused health education interventions and quality improvement programs tailored to men who engage in unhealthy behaviors to improve their PSA test awareness.
Prostate-Specific Antigen; Awareness; Smoking; Obesity; Exercise
BACKGROUND: Black American men continue to suffer disproportionately from epidemically higher rates of prostate cancer. We hypothesize that complex reasons for persistently higher death rates of prostate cancer in this group are steeped in social factors associated with health access. METHODS: We utilized data from the It's All About U prostate cancer prevention study among black men to investigate: 1) what social ecological factors were predictive of prostate-specific antigen (PSA) testing and digital rectal examinations (DRE); 2) if black men were aware of prostate cancer screening and, if screening was available, would they take the PSA and DRE? Quantitative cross-sectional data from a cohort of 276 black men with no diagnosis of prostate cancer were analyzed to identify characteristics, beliefs, practices and attitudes of this group toward prostate cancer screening. We created a social ecological model to examine which social factors (i.e., environmental, personal, person/environment interplay, black culture and institutional policy) were predictive of PSA and DRE, PSA only and DRE only. To reduce data and identify data patterns, factor analyses (tested for reliability by calculating Cronbach alpha scores) were performed. Variables were standardized with Z scores and analyzed with predictive analytic software technology (SPSS, version 12). A multivariate binary logistic regression was conducted to identify predictors of PSA and DRE. RESULTS: A significant predictor of both PSA and DRE was the physician's direct prostate cancer communication message (P<0.010). Significant correlations exist in PSA and DRE outcomes with a physician's engaging communication style (P<0.012), encouragement to screen (P<0.001) and sharing prostate cancer information (P<0.001); as was men understanding the serious risk of prostate cancer (P<0.001), culture (P<0.004), positive interaction with healthcare staff, significant other(s) and providers (P<0.001), and environmental dimensions (P<0.006). A profile of four major self-reported barriers to screening were identified (i.e., fear, internal locus of health, comfort level and external locus of health). Lastly, men who utilized health systems with a prostate cancer screening policy had high percentages of PSA and DRE (63.3%), PSA only (70.9%) and DRE only (81.7%). CONCLUSION: A physician's aggressive, positive engagement in shared decision-making, tailored social influences promoting prostate cancer prevention among black men, as well as institutional screening policy, has the potential to increase early detection and reduce morbidity among this group.
To explore the attitudes of men with confirmed or suspected prostate cancer to testing for prostate specific antigen.
Qualitative interview study with a purposive sample.
52 men with suspected or confirmed prostate cancer, recruited through general practitioners, urologists, patient support groups, and charities.
Almost all men remembered their prostate specific antigen test but recalled being given little information beforehand. Arguments in favour of increased access to testing included the belief that early diagnosis would reduce mortality, improve quality of life, and save the NHS money. Men also thought that a national screening programme should be available because symptoms can be ambiguous, screening for cancer is responsible health behaviour, and screening would encourage men to be tested. Four men who opposed a screening programme had gathered information alerting them to uncertainty about the benefits of treatment, and two regretted that they had been tested. Others thought that access to testing is restricted in the United Kingdom because of a lack of government backing, concerns about the accuracy of the test, and a lack of resources.
The few men in this study who subscribed to the argument that evidence of the benefits of treatment is a prerequisite for a screening programme did not want to see screening introduced. Men who proposed an alternative set of principles for testing gave reasons that did not all relate to overoptimism about the benefits of early diagnosis. People who plan services and people who respond to requests for testing need to understand men's perspectives and concerns.
What is already known on this topicThe media report enthusiasm for both testing and screening for prostate specific antigen among men with prostate cancerRelatively little is known about men's experiences of such testingWhat this study addsThe study helps to explain why most men with prostate cancer strongly advocate prostate specific antigen testing and screeningIt also shows that many men are ill prepared for test results and for the possible iatrogenic effects of treatment
The search for susceptibility loci in hereditary prostate cancer (HPC) has proven challenging due to genetic and disease heterogeneity. Multiple risk loci have been identified to date, however few loci have been replicated across independent linkage studies. In addition, most previous analyses have been hampered by the relatively poor information content provided by microsatellite scans. To overcome these issues, we have performed linkage analyses on members of 301 HPC families genotyped using the Illumina SNP linkage panel IVb. The information content for this panel, averaged over all pedigrees and all chromosomes, was 86% (range 83–87% over chromosomes). Analyses were also stratified on families according to disease aggressiveness, age at diagnosis and number of affected individuals to achieve more genetically homogeneous subsets. Suggestive evidence for linkage was identified at 7q21 (HLOD = 1.87), 8q22 (KCLOD = 1.88) and 15q13–q14 (HLOD = 1.99) in 289 Caucasian families, and nominal evidence for linkage was identified at 2q24 (LOD = 1.73) in 12 African American families. Analysis of more aggressive prostate cancer phenotypes provided evidence for linkage to 11q25 (KCLOD = 2.02), 15q26 (HLOD = 1.99) and 17p12 (HLOD = 2.13). Subset analyses according to age at diagnosis and number of affected individuals also identified several regions with suggestive evidence for linkage, including a KCLOD of 2.82 at 15q13–q14 in 128 Caucasian families with younger ages at diagnosis. The results presented here provide further evidence for a prostate cancer susceptibility locus on chromosome 15q and demonstrate the power of utilizing high information content SNP scans in combination with homogenous collections of large prostate cancer pedigrees.
Recent admixture mapping and linkage/association studies have implicated an ~1 Mb region on chromosome 8q24 in prostate cancer susceptibility. In a subsequent follow-up investigation, Haiman et al. (Nat Genet 2007;39:638-44) observed significant, independent associations between 7 markers within this region and sporadic prostate cancer risk in a multi-ethnic sample. To clarify the risk associated with hereditary prostate cancer, we tested for prostate cancer association with 6 of these 7 markers in a sample of 1,015 non-Hispanic white men with and without prostate cancer from 403 familial and early-onset prostate cancer families. Single nucleotide polymorphisms (SNPs) rs6983561 and rs6983267 showed the strongest evidence of prostate cancer association. Using a family-based association test, the minor (“C”) allele of rs6983561 and the major (“G”) allele of rs6983267 were preferentially transmitted to affected men (p < 0.05), with estimated odds ratios (ORs) of 2.26 (95% confidence interval of 1.06–4.83) and 1.30 (95% confidence interval of 0.99–1.71), respectively, for an additive model. Notably, rs6983561 was significantly associated with prostate cancer among men diagnosed at an early (<50 years) but not later age (p = 0.03 versus p = 0.21). Similarly, the association with rs6983267 was (not) statistically significant among men with(out) clinically aggressive disease (p = 0.007 versus p = 0.34). Our results confirm the association of prostate cancer with several of the SNPs on chromosome 8q24 initially reported by Haiman et al. In addition, our results suggest that the increased risk associated with these SNPs is approximately doubled in individuals predisposed to develop early onset or clinically aggressive disease.
prostate; cancer; genetics; chromosome 8; risk
To explore cancer information acquisition patterns among African-American men and to evaluate relationships between information acquisition patterns and prostate cancer prevention and control knowledge.
A random sample of 268 men participated in a state wide interviewer administered, telephone survey.
Men classified as non seekers, non medical source seekers, and medical source seekers of prostate cancer information differed on household income, level of education, and beliefs about personal risk for developing prostate cancer. Results from multiple regression analysis indicated that age, education, and information seeking status were associated with overall levels of prostate cancer knowledge. Results from logistic regression analyses indicated that men who included physicians as one of many information resources (medical source seekers) had superior knowledge over non seekers and non medical source seekers on 33% of individual knowledge details.
The findings emphasize the need to connect lower income and lower educated African-American men to physicians as a source of prostate cancer control information.
Although African-American men have a greater burden of prostate cancer than whites and other racial and ethnic groups, few studies on the burden of prostate cancer have focused on African Americans specifically. We used a sample of African-American men (N = 736) who participated in the 2000 National Health Interview Survey to explore their awareness of the prostate-specific antigen (PSA) test. Among African-American men aged > or = 45 with no history of prostate cancer, 63% had heard of the PSA test and 48% had been tested. Bivariate analyses showed significant associations between sociodemographic, family composition, health status and perceived risk with having heard of the PSA test and having been tested. The multivariate model showed significant associations between having heard of the PSA test and age, level of education, living in an MSA, and having private or military health insurance. For ever being tested, the multivariate model showed significant associations for age, private or military health insurance, being in fair or poor health, and having a family history of prostate cancer. Some of the correlates, such as age, increased levels of education and being married, were consistent with previous studies, but other correlates, such as metropolitan statistical area, health status and perceived risk, differed from previous studies.
This article is intended as a review of the available clinical data outlining the risks and benefits of testosterone (androgen) replacement therapy, specifically addressing the issue of the relationship between exogenous androgen administration and prostate cancer risk. There is controversy over whether androgen replacement is a risk factor for incident prostate cancer. Our review of current clinical information revealed that to date, no study or review has definitively shown that androgen replacement therapy is an independent risk factor for development of prostate cancer. Androgen administration seems to be beneficial in decreasing fatal cardiovascular events, body fat mass, and insulin resistance. Overall, the current clinical data seems to suggest that androgen replacement is an appropriate therapeutic option for men with symptomatic hypogonadism provided that patients continue to receive regular prostate screenings.
Androgen replacement; hypogonadism; prostate
BRCA1/2 testing is one of the most well-established genetic tests to predict cancer risk. Guidelines are available to help clinicians determine who will benefit most from testing.
To identify women at high risk of hereditary breast and ovarian cancer and estimate their awareness of and experience with genetic testing for cancer risk.
Analyses of the 2000 and 2005 National Health Interview Surveys.
Women with no personal history of breast or ovarian cancer (n = 35,116).
Risk of hereditary breast or ovarian cancer based on self-reported family history of cancer and national guidelines; self-reported awareness of genetic testing for cancer risk; discussion of genetic testing for cancer risk with a health professional; having undergone genetic testing for breast/ovarian cancer risk.
Using guideline criteria, 0.96% of women were identified as being at high risk of hereditary breast and ovarian cancer. Among high-risk women, 54.04% were aware of genetic testing for cancer risk, 10.39% had discussed genetic testing with a health professional, and 1.41% had undergone testing for breast/ovarian cancer risk. Adjusting for survey year, high-risk women were more likely than average-risk women to have heard of genetic testing for cancer risk (RR, 1.3, 95% CI 1.2-1.4), to have discussed genetic testing with a health professional (RR 5.2, 95% CI 3.6-7.4), and to have undergone genetic testing for breast/ovarian cancer risk (RR 6.8, 95% CI 2.6-18.0).
We find low provision of guideline-recommended advice to women for whom testing may be appropriate and of significant clinical benefit.
guidelines; genetic risk assessment; hereditary; breast cancer; ovarian cancer; BRCA1/2 testing
Previous quantitative studies have not compared the use of prostate and colorectal cancer testing between gay/bisexual and heterosexual men.
We analyzed cross-sectional data on 19,410 men in the California Health Interview Survey. The percentage of respondents age 50 and over who received prostate and colorectal cancer tests was calculated across subgroups defined by self-reported sexual orientation, race/ethnicity, and a combined variable on sexual orientation and race/ethnicity. Multivariate regression analysis was used to identify variables on respondent characteristics that were independently associated with testing.
In bivariate analyses, the percentage of gay/bisexual men receiving colorectal cancer tests was 6%-10% greater than that of heterosexuals. There were no overall differences in prostate-specific antigen test use between gay/bisexual and heterosexual men; however, use of these tests by gay/bisexual African Americans was 12%–14% lower than that of heterosexual African Americans and 15%–28% lower than that of gay/bisexual Whites. In multivariate analyses, gay/bisexual men had greater odds of ever receiving colorectal cancer tests (odds ratio [OR]=1.67; 95% confidence interval [CI]=1.06, 2.65), and lower odds of having an up-to-date prostate-specific antigen test than did heterosexuals (OR=0.61; CI=0.42, 0.89). However, interactions between sexual orientation and living situation showed that gay/bisexual men who lived alone had greater odds of receiving prostate-specific antigen tests than did other men (OR=1.93; CI=1.23, 3.03).
Sexual orientation is independently associated with cancer testing among men. Future work should investigate the differences in this association by race/ethnicity and living situation.
Preventive services; prostate cancer; colorectal cancer; men; sexuality
Informed decision making is the theoretical basis in the UK for men's decisions about Prostate Specific Antigen (PSA) testing for prostate cancer testing. The aim of this study is to evaluate the effect of a web-based PSA decision-aid, Prosdex, on informed decision making in men. The objective is to assess the effect of Prosdex on six specific outcomes: (i) knowledge of PSA and prostate cancer-related issues – the principal outcome of the study; (ii) attitudes to testing; (iii) decision conflict; (iv) anxiety; (v) intention to undergo PSA testing; (vi) uptake of PSA testing. In addition, a mathematical simulation model of the effects of Prosdex will be developed.
A randomised controlled trial with four groups: two intervention groups, one viewing Prosdex and the other receiving a paper version of the site; two control groups, the second controlling for the potential Hawthorn effect of the questionnaire used with the first control group. Men between the ages of 50 and 75, who have not previously had a PSA test, will be recruited from General Practitioners (GPs) in Wales, UK. The principal outcome, knowledge, and four other outcome measures – attitudes to testing, decision conflict, anxiety and intention to undergo testing – will be measured with an online questionnaire, used by men in three of the study groups. Six months later, PSA test uptake will be ascertained from GP records; the online questionnaire will then be repeated. These outcomes, and particularly PSA test uptake, will be used to develop a mathematical simulation model, specifically to consider the impact on health service resources.
Current Controlled Trial: ISRCTN48473735.
Genetic testing for hereditary forms of cancer does not always identify a causative mutation. Little is known about personal or family response to these indeterminate results when a hereditary form of cancer is suspected. This study explored thoughts about and responses to risk for hereditary non-polyposis colorectal cancer (HNPCC) when a family member has received indeterminate genetic test results.
In this qualitative study, data were gathered from index cases who received indeterminate genetic test results through a longitudinal study offering genetic counseling and testing for HNPCC. First-degree relatives of these indeterminate index cases were also invited to participate in the qualitative interview.
Semi-structured telephone interviews were conducted with index cases and their at-risk first-degree relatives. Data were analyzed using the within- and across-case method.
The across-case analysis led to the development of the Awareness and Surveillance Trajectory, which describes individual interpretations of and responses to risk, based on personal and family history. Explanations of risk addressed the meaning of cancer in the family and provided context for individual interpretations. They were identified using within-case analysis and organized into a typology: innate, exceptional, idiosyncratic, and undeveloped explanations.
Members of families without identified HNPCC mutations vary in their explanations for, interpretations of, and responses to indeterminate genetic test results.
Explanations of family risk and interpretations of individual risk offer health care providers valuable information. In combination with the Awareness and Surveillance Trajectory, assessment of these beliefs can facilitate development of individualized recommendations and strategies for possible preventive actions.
African-American men die from prostate cancer at higher rates than white men, a health disparity that may result from differences in knowledge and beliefs about prostate cancer and screening. Studies conflict on whether race or socioeconomic status affects knowledge of prostate cancer and screening. This study compared education, race, and screening status to determine how each factor alone or together shape men’s knowledge of prostate cancer and screening.
In-depth interviews were conducted with 65 African-American and white men with diverse education backgrounds, aged 40–64.
Education, not race or screening status, was associated with knowledge about the prostate gland, prostate cancer symptoms and screening tests, and fear of prostate cancer. The exception was knowledge about the prostate specific antigen blood test which was associated with education and screening status.
Education, not race, is associated with prostate cancer and screening knowledge. Interventions should focus on all men with low education to correct their misinformation about prostate cancer and to engage them in shared decision making about screening.
prostate cancer; prostate cancer screening; health disparities; African-American
Prior studies report statins may reduce the risk of advanced prostate cancer. This study investigates the association between statin use and the likelihood of having a PSA or DRE test, blood PSA levels, prostate volume, and the severity of lower urinary tract symptoms. We also describe the association between statin use and prostate cancer and high-grade prostatic intraepithelial neoplasia (PIN) before and after controlling for prostate cancer screening indices associated with statin use.
The Nashville Men's Health Study used a multicenter, rapid recruitment protocol to collect clinical, biological, behavioral and body measurement data from 2,148 men 40 years or older scheduled for diagnostic prostate biopsy. Medication use and other data were ascertained by research survey, clinical interview, and chart review.
Approximately 37% of participants were taking a statin. Statin use was significantly associated with a 12% lower PSA levels and 8% smaller prostate volume after controlling for age, race, BMI, WHR, aspirin use, other comorbidity. Simvastatin was more strongly associated with prostate volume, while atorvastatin was associated with PSA. Statin use was marginally associated with increasing PSA test frequency among men with undiagnosed cancer. Statin use was not associated with the frequency or results of digital rectal exams, lower urinary tract symptom severity, high-grade (Gleason >6) prostate cancer (OR=0.95 (0.73, 1.24)), low-grade (Gleason = 6) prostate cancer (OR=1.11 (0.86, 1.42)) or PIN (OR=0.82, (0.57, 1.17)). Additional control for the number of prior PSA tests, PSA levels, and prostate volume did not alter these results.
These results suggest selective referral for biopsy associated with statin use is an essential element to address in further understanding the potential for statins to prevent prostate cancer.
prostate cancer; PSA; Statin; prostate volume; bias
PTEN (phosphatase and tensin homolog deleted on chromosome 10) functions as a major tumor suppressor gene and is frequently deleted in different types of tumors including prostate cancer (PCa). It was hypothesized that germ-line genetic changes of PTEN affect susceptibility to PCa. Both common (with a minor allele frequency ≥5%) and rare (with a minor allele frequency <5%) germ-line variants of PTEN were comprehensively evaluated. A total of 15 germ-line variants were identified by re-sequencing the PTEN gene, including 5′ untranslated region, all nine exons, exon-intron junctions and 3′ untranslated region, in 188 probands of hereditary prostate cancer (HPC) families recruited from Johns Hopkins Hospital. Two microsatellite markers surrounding PTEN were used to test the co-segregation of 10 rare variants, which may give rise to highly penetrant in HPC. Two common single nucleotide polymorphisms (SNPs) were evaluated in the 188 HPC families using a family-based association study approach. To study low penetrant SNPs in PCa susceptibility, 33 SNPs covering PTEN were selected from the whole genome-wide association studies (GWAS) from our available case-control studies in Sweden (Cancer of the Prostate in Sweden (CAPS)) and the publicly available cancer genetic markers of susceptibility (CGEMS) study. Germ-line copy-number variations (CNVs) in PTEN were assessed in CAPS. Co-segregation of germ-line variants and PCa was not observed among HPC families and no significant differences in the allele frequencies were observed in sporadic cases and controls, aggressive and non-aggressive PCa (P >0.05). These results suggest that germ-line variants in PTEN do not have an important role in PCa susceptibility.
co-segregation; family-based association; population-based association; prostate cancer; PTEN; sequencing
Men who have a brother with prostate cancer have a two-fold increased risk of being diagnosed with prostate cancer. Strategies employed by these men to reduce prostate cancer risk are not well understood. Preliminary studies have shown that men with a family history of prostate cancer have a high rate of vitamin and supplement usage aimed at the prevention of prostate cancer.
We analyzed data from a cross-sectional study of men with familial and hereditary prostate cancer and their unaffected brothers. We interviewed 542 unaffected men who had at least one brother who had been diagnosed with prostate cancer regarding their use of vitamins and supplements, as well as the motivation for use.
The associations between subject characteristics and vitamin and supplement use were evaluated using an unconditional logistic regression modeling approach.
Overall, 59.2 and 36.5 percent of men reported ever using and currently using, respectively, one or more vitamins or supplements (including multivitamins). One-third of men took a vitamin or supplement that has been targeted for prostate health or cancer prevention, including green tea, magnesium, male hormones, saw palmetto, selenium, soy, vitamins A, C, E and zinc. Increasing age at time of survey was associated with vitamin/supplement use (OR=1.03; 95% CI=1.01–1.0). After adjusting for age at time of survey, being younger than an affected brother was associated with vitamin and supplement use (OR=1.51; 95% CI=1.01–2.25). 25% of men reported obtaining information from books or articles as the most common source of information.
Our findings indicate that men at an increased risk for prostate cancer report a high rate of vitamin and supplement use, including supplements targeted for prostate cancer prevention. Men with a family history of prostate cancer represent a target population for future chemopreventative agents.
Prostate Cancer Chemoprevention; Family History; Complementary and Alternative Medicine
The management of all stages of prostate cancer is an increasingly complex process and involves a variety of available treatments and many disciplines. Despite prostate-specific antigen (PSA) testing, the presentation of prostate cancer at a locally advanced stage is common in the UK, accounting for one-third of all new cases. There is no universally accepted definition of locally advanced prostate cancer; the term is loosely used to encompass a spectrum of disease profiles that show high-risk features. Men with high-risk prostate cancer generally have a significant risk of disease progression and cancer-related death if left untreated. High-risk patients, including those with locally advanced disease, present two specific challenges. There is a need for local control as well as a need to treat any microscopic metastases likely to be present but undetectable until disease progression. The optimal treatment approach will therefore often necessitate multiple modalities. The exact combinations, timing and intensity of treatment continue to be strongly debated. Management decisions should be made after all treatments have been discussed by a multidisciplinary team (including urologists, oncologists, radiologists, pathologists and nurse specialists) and after the balance of benefits and side effects of each therapy modality has been considered by the patient with regard to his own individual circumstances. This article reviews the current therapy options.
antiandrogens; prostate cancer; prostatectomy