MEN’S ATTITUDES REGARDING GENETIC TESTING FOR HEREDITARY PROSTATE CANCER RISK SUSAN MIESFELDT, SUSAN M. JONES, WENDY COHN, MARGUERITE LIPPERT, KATHLEEN HADEN, BEVERELY L. TURNER, TRACEE MARTIN-FRIES, AND STEPHANIE M. CLARK ABSTRACT Objectives. Little is known about the attitudes of men unselected for a family history for prostate cancer concerning genetic testing for prostate cancer risk or genetic testing for inherited cancer predisposition. To explore this, we examined the interest in molecular testing for hereditary prostate cancer (HPC) predispo- sition among a self-selected cohort of 342 men presenting for prostate cancer screening. Methods. Participants were surveyed concerning their attitudes about DNA testing for HPC predisposition and knowledge of prostate cancer-associated risk factors, including heredity. Results. Of the participants completing the survey, 92% expressed interest in learning about DNA testing, and 89% stated that they would undergo DNA analysis for HPC predisposition, if available. Twenty-eight percent of respondents failed to demonstrate an adequate understanding of the concept of “inherited tendency.” The demonstrated level of understanding of this concept did not differ by the respondent’s family history, although it varied by race. An interest in learning about or undergoing testing did not vary by race, family history, or demonstrated understanding of the concept of inherited risk. Conclusions. Among men presenting for routine prostate cancer screening, interest in learning about testing for HPC predisposition and in having such testing performed may be high. The data also provide evidence that, in a population of men unselected for family history, interest in molecular testing for this common, male-specific cancer may parallel the high interest level demonstrated among women in DNA testing for inherited breast and ovarian cancer risk. UROLOGY 55: 46–50, 2000. © 2000, Elsevier Science Inc. F amilial clustering of prostate cancer has led to the recognition of a subset of the disease termed “hereditary prostate cancer” (HPC), 1,2 characterized as a subtype of familial prostate can- cer with a pattern of disease consistent with Men- delian inheritance. 2 HPC is defined as disease oc- curring in families with one or more of the following characteristics: three or more affected in- dividuals within one nuclear family, affected indi- viduals from three successive generations, and/or two or more relatives with the disease before 55 years of age. 3 The molecular etiology of HPC has only recently begun to emerge. Linkage studies have localized a susceptibility locus, HPC1, to chromosome 1. 4–7 Prostate cancer in individuals from families potentially linked to HPC1 is charac- terized by a younger age at onset, higher nuclear grade of tumors, and a later stage at diagnosis. 7,8 More recently, three additional HPC genes have been localized. 9 –11 Previous work has shown significant interest in genetic testing for HPC predisposition among men with a positive family history. 12 The study of Bratt et al. 12 assessed the attitudes of 69 men affected by prostate cancer and 101 of their unaffected sons about prostate cancer screening and genetic coun- seling/DNA testing for HPC predisposition. Ap- proximately 90% of the sons expressed interest in prostate cancer screening, information about HPC, and genetic analysis for HPC predisposition. Among the fathers, 91% wanted their sons to learn about the potentially hereditary nature of their prostate cancer risk, and 97% would want their sons to undergo HPC predisposition testing, if available. However, the level of interest in this test- From the Division of Hematology/Oncology, Department of Inter- nal Medicine; Cancer Center; and Departments of Health Evalu- ation Sciences and Urology, University of Virginia School of Med- icine; and Department of Chemistry, University of Virginia College of Arts and Sciences, Charlottesville, Virginia Reprint requests: Susan Miesfeldt, M.D., Division of Hematol- ogy/Oncology, University of Virginia Health System, Box 513, Jordan Hall Annex, Charlottesville, VA 22908 Submitted: May 6, 1999, accepted (with revisions): August 19, 1999 ADULT UROLOGY © 2000, ELSEVIER SCIENCE INC. 0090-4295/00/$20.00 46 ALL RIGHTS RESERVED PII S0090-4295(99)00400-8