PCN1: CATEGORIZATION OF RISK OF PROSTATE CANCER: PILOT TEST OF CLINICAL OUTCOMES AND RISK PERCEPTIONS

Abstract

OBJECTIVES: To define clinically useful categories for prostate cancer (PC) risk and associated outcomes. Translating relative risk (RR) and cumulative risk (CR) into risk categories is important if studies of PC epidemiology and genetic predisposition are to have clinical utility for education, counseling and decision-making. Individual risk perceptions compared to clinical risk are important for the study of behavioral outcomes. METHODS: Risk categories were determined by an extensive review of the literature. Using RR and CR for specific risk factors, 4 categories were defined from low to very high. The categories were then used to assess PC outcomes in men at increased risk for PC (defined by race and family history). Risk perceptions were assessed by asking men to rate their chance of getting PC on a scale from 0 to 100%. RESULTS: 264 men participated in this study. Mean age was 47.7 years, and 52% were African American, 48% were Caucasian. By nature of study eligibility, only 3(1%) men were in the low risk category. According to study criteria, 54(20%) were in the moderate risk, 129(49%) in the high risk, and 62(24%) in the very high risk categories, 16(6%) were unknown. PC was diagnosed in 0 of the low and unknown, 7% of the moderate, 5% of the high and 10% of the very high-risk groups. Of the 62 men who answered the risk perception item, there was no correlation between risk category and risk perceptions. CONCLUSIONS: Lacking a Gail-like model for PC risk, the search continues for quantifiable risk categories with clinical utility. The extreme categories proposed in this pilot study show a trend toward clinically meaningful categorization of PC risk. A meta-analysis of RR and CR is underway to refine the categories. Risk categories and risk perceptions were not associated, as has been shown in breast cancer.