Two men have low-grade prostate cancer, limited Gleason 3+3 disease, and both are good candidates for active surveillance (AS). But their risk may not be the same, a new Brady study has found.

Investigators led by former fellow Claire de la Calle, M.D., and Christian Pavlovich, M.D., the Bernard L. Schwartz Distinguished Professor of Urologic Oncology, found that men with a first-degree family history of prostate cancer face a higher risk of cancer progression during active surveillance for low-grade prostate cancer.

In the study, published in European Urology Oncology, the team analyzed data from 1,421 patients to assess whether a family history of prostate or other cancer influenced the likelihood of grade reclassification on biopsy – an indication that the disease may be becoming more aggressive. “We found that men with a family history of prostate cancer, or prostate cancer plus breast, ovarian, and/or pancreatic cancer, had significantly increased risks of grade reclassification to intermediate risk of prostate cancer, including to Gleason grade group 3,” says Pavlovich. However, a family history of breast, ovarian, or pancreatic cancer alone did not significantly raise this risk.”

Good news: Even though there was a higher risk of progression in men with a family history of prostate cancer, “we found no significant association with adverse pathological features, such as high pathologic Gleason score, seminal vesicle invasion, or lymph node involvement at the time of radical prostatectomy. Their long-term outcomes after surgical treatment are not worse than those without a cancer-related family history.”

Based on these findings, AS is still a good option with low-grade prostate cancer, “even among those with a family history of prostate or of some other cancers,” says Pavlovich. However, these patients may need closer monitoring. “Future research may further refine surveillance recommendations, based on more extended family history or genetic markers.”