Jeffrey Smith, MD, PhD

Prostate cancer risk runs in families. A man’s risk of prostate cancer roughly doubles for every close family member who has been affected. Men in the family also tend to share how aggressive the cancer is. For example, how long a father survives with the cancer is strongly predictive of a how long a son will survive with the cancer. Studies have uncovered genetic risk factors for prostate cancer that distinguish which men are at high risk. But these factors poorly predict disease course. Two separate features of a cancer predict how aggressive it will be. These are 1) how abnormal the cancer cells are and 2) extent of cancer spread. Using such clinical features, two-thirds of cases are thought to be less aggressive and follow a watch-and-wait strategy. But over half advance and require active treatment. Ability to better recognize the path that the cancer is likely to take is needed. This is a study to discover the factors passed down in families that guide this path. The study also tests whether these factors predict which men followed by watch-and-wait will advance and require treatment.