Familial and Hereditary Prostate Cancer

Sammanfattning: This thesis is based on research concerning epidemiological, clinical, and psychological aspects of familial and hereditary prostate cancer. Epidemiology: Male first-degree relatives of prostate cancer patients had a three-fold increased prostate cancer risk. The risk was higher for relatives of younger patients than for relatives of older patients, most likely due to the effect of the higher prevalence of hereditary prostate cancer found among the former. For first-degree relatives of men with early onset prostate cancer, the risk of developing prostate cancer before the age of 70 years was increased 3.4 times, but their total cancer risk was not increased. Short CAG repeats in the androgen receptor gene correlated with early age at diagnosis of non-hereditary prostate cancer, but not with the risk of developing the disease per se. Clinical aspects: Patients with hereditary prostate cancer were diagnosed, on an average, 7 years earlier than those with sporadic prostate cancer. Family history of prostate cancer was not significantly associated with survival for patients with early onset disease. Psychological aspects: Most men with a family history of prostate cancer worried about the possibility of inheriting the disease. Almost all of them (90-94%) had positive attitudes towards genetic investigations, including genetic testing, and screening. Forty percent of unaffected men in families with hereditary prostate cancer substantially overestimated their lifetime risk of the disease. Perception of high risk was associated with symptoms of depression and cancer worries that affected daily living. High levels of cancerspecific stress may have counteracted participation in screening for some men.