prostate cancer early detection and awareness…..”can’t win for losing”

to fish or to stick....that is the question


The following article and ones like it were all over the place over the last week. Cancers may be more prevalent in relatives because they are tested more.  Isn’t that what we wanted, I mean awareness and early detection? What if all men had the sense of awareness that family members of prostate cancer patients had.  This is an example of how things get discombobulated. Is the alternative for family members not to be tested?

Several sayings come to  mind: You can’t have it both ways, You’re damned if you do and damned if you don’t, and of course a great Elvis Costello line from one of his songs, ” I can’t stand  up for falling down.” So read the article and pretend that your father has prostate cancer and you are a male at risk. What are you going to do? Did this article influence anything that you will do? Okay, what purpose did it serve?

Familial prostate cancer risk influenced by screening awarenessBy Sarah Guy23 August 2010J Natl Cancer Inst 2010; Advance online publicationMedWire News: Men with first-degree relatives who have prostate cancer are more likely to undergo prostate-specific antigen (PSA) screening than those with no family history, report researchers who believe that the finding may bias the results of genetic studies investigating familial prostate cancer risk.

Compared with the general population, men who have one or more brothers with prostate cancer have increased diagnostic activity, especially those of a high economic status, and particularly during the first year after the initial sibling is diagnosed, say the researchers.

Ola Bratt (Helsingborg Hospital, Sweden) and colleagues suggest that, “when counseling men about their risk for hereditary predisposition to prostate cancer, one should consider the possibility that a familial aggregation of prostate cancer may be at least partially caused by increased diagnostic activity.”

The researchers investigated the effect of increased diagnostic activity among men with a family history of prostate cancer on their risk for the disease, using data for 13,975 prostate cancer patients and their 22,511 unaffected brothers from the Prostate Cancer Database Sweden.

The overall incidence of prostate cancer among the brothers of index patients (for whom one or more brothers and their father could be identified by national registries) was 3.1 times higher than men of the same age in the general Swedish population, write Bratt et al in the Journal of the National Cancer Institute.

The risk for stage T1c cancer was far higher among brothers of index patients (standard incidence ratio [SIR]=3.4) compared with the risk for metastatic disease, (SIR=2.0).

Additionally, among brothers of index prostate cancer patients, the incidence of prostate cancer was much higher during the first year after the index patient’s diagnosis than during later years, at SIR 3.6 versus 2.5 and 2.8 at 5 years or more and 1-3 years, respectively.

Higher socioeconomic status (defined according to employment status) of the index patient was also associated with a higher risk for a prostate cancer diagnosis, and a diagnosis of low-risk disease among their brothers.

Brothers of high socioeconomic status patients had an SIR of 4.2 for T1c tumors compared with an SIR of 2.8 for brothers of low socioeconomic status patients.

In an accompanying editorial, Ian Thompson (University of Texas, Austin, USA) and colleagues comment: “Perhaps the best tactic would be to change our approach from seeking risk factors for prostate cancer to an assessment of factors related to biologically consequential prostate cancer.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010


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