Clinical and histopathological characteristics of familial prostate cancer in Finland.

OBJECTIVE To describe clinical and histopathological characteristics of Finnish familial prostate cancer (PCa) through a detailed analysis of cases in families. PATIENTS AND METHODS In total, 202 Finnish families with 617 histopathologically confirmed PCa cases of confirmed genealogy were collected. Complete clinical data, including age and prostate-specific antigen (PSA) at diagnosis, stage, grade and primary treatment, were gathered. The mean (range) number of affected men per family was 3 (2-8). All the available diagnostic biopsy samples (n = 323) were collected and regraded by the same uropathologist. A population-based cohort of 3011 hospital district Pirkanmaa PCa patients was used as a control group. RESULTS The mean (range) year of diagnosis of PCa was 1993 (1962-2006) and the mean (range) age at diagnosis was 68 (43-98 years). The median (range) primary PSA level was 12.0 (0.8-11 000) ng/mL. After regrading, the Gleason score was = 6 in 38%, 7 in 37% and = 8 in 25% of men. The subset of familial PCa men diagnosed after 1995 had higher PSA levels (P = 9.9 x 10-6) and an earlier age of onset (P = 1.7 x 10-6) than men in the control group, although there were no differences in cancer-specific survival. CONCLUSIONS We observed an earlier age of onset and higher PSA in familial PCa. However, differences between sporadic and familial or hereditary PCa cannot be truly solved until genetic testing of high-risk genes in addition to family history is used to define PCa families. We also emphasize that, when histological samples are collected over a longer study period, reanalysis of the samples by the same experienced uropathologist should be considered.