1. ¹National Human Genome Center, Howard University, Washington, DC, USA
2. ²Division of Urology, Howard University, Washington, DC, USA
3. ³Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
4. ⁴Department of Microbiology, Howard University, Washington, DC, USA
5. ⁵MD Anderson Medical Center, Houston, Texas, USA
6. ⁶Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
7. ⁷Department of Pediatrics, Howard University, Washington, DC, USA
8. ⁸University of Illinois, Chicago, Illinois, USA
9. ⁹Midtown Urology, Atlanta, Georgia, USA
10. ¹⁰Columbia-Presbyterian Medical Center, New York, New York, USA
11. ¹¹Michael Reese Hospital, Chicago, Illinois, USA
12. ¹²National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
13. ¹³Translational Genomics Research Institute, Genetic Basis of Human Disease Research Division, Phoenix, Arizona, USA
14. ¹⁴University of South Carolina, Columbia, South Carolina, USA

Correspondence: C Ahaghotu, Division of Urology, Howard University Hospital, 2041 Georgia Avenue Suite 4C02, Washington, DC 20060, USA. E-mail: cahaghotu@howard.edu

Received 7 October 2003; Revised 10 March 2004; Accepted 12 March 2004.

Abstract

Introduction: The African-American Hereditary Prostate Cancer (AAHPC) Study was designed to recruit African-American families fulfilling very stringent criteria of four or more members diagnosed with prostate cancer at a combined age at diagnosis of 65 years or less. This report describes the clinical characteristics of a sample of affected AAHPC family members.

Methods: In all, 92 African-American families were recruited into the study between 1998 and 2002. Complete clinical data including age and PSA at diagnosis, number of affected per family, stage, grade, and primary treatment were available on 154 affected males. Nonparametric Wilcoxon two-sample tests and Fisher's exact test (two-tailed), were performed to compare families with 4–6 and >6 affected males with respect to clinical characteristics.

Results: The mean number of affected men per family was 5.5, with a mean age at diagnosis of 61.0 (8.4) years. Age at diagnosis, PSA and Gleason score did not show significant differences between the two groups of families. Based on the Gleason score, 77.2% of affected males had favorable histology. Significantly, there were marked differences between the two groups in the frequency of node-positive disease (P=0.01) and distant metastases (P=0.0001). Radical prostatectomy was the preferred primary therapy for 66.2% of all affected men followed by 20.8% who chose radiation therapy.

Conclusions: Our findings suggest that affected males who carry the highest load of genetic factors are at the highest risk for early dissemination of disease, thus efforts at early diagnosis and aggressive therapeutic approaches may be warranted in these families. Since the primary therapy choices in our study favored definitive treatment (87.0%) when compared to the 1983 and 1995 SEER data in which 28 and 64% received definitive treatment, respectively, it appears that affected African-American men in multiplex families may be demonstrating the reported psycho-social impact of family history on screening practices and treatment decisions for prostate cancer.