家族史（FH）中有前列腺癌（PCa）与PCa的风险增加和不良疾病特征有关。然而，FH患有局部PCa是否可考虑主动监测（AS）仍存在争议。评估FH与AS候选人再分类之间的关联，并定义具有阳性FH的男性不良结局的预测因素。总共，确定了在单个机构AS协议中包括656名GG1 PCa患者。Kaplan-Meier分析评估了重新分类的时间（随访活检中的GG≥2和GG≥3）总体和根据FH状态分类。多变量Cox回归测试了FH对重新分类的影响，并确定了在FH男性中的预测因素。识别接受延迟根治性前列腺切除术（n = 197）或外束放疗（n = 64）的男性，并评估FH对肿瘤学结果的影响。总的来说，119名男性（18%）有FH。中位随访时间为54个月（四分位距29-84个月），264名患者经历了重新分类。5年的再分类自由生存率为FH和无FH之间的57%和39%（p = 0.006），FH与GG≥2的重新分类有关（风险比[HR]为1.60，95%置信区间[CI]为1.19-2.15，p = 0.002）。在FH男性中，重新分类的最强预测因素是前列腺特异性抗原密度（PSAD）、高体积GG1（≥33%的核心涉及或≥任何核心的50%）和前列腺磁共振成像（MRI）可疑（HR分别为2.87，3.04和3.87；所有p <0.05）。未观察到FH、不良病理特征和生化复发之间的关联（所有p> 0.05）。AS患有FH的患者有再分类的风险增加。阴性MRI、低疾病体积和低PSAD识别具有FH的男性，以及低再分类风险。然而，样本大小和广泛的CI需要谨慎使用这些结果得出结论。我们在局限性前列腺癌患者中测试了FH的影响，并发现重分类的显著风险，但推迟治疗后不良肿瘤学结果问题需要谨慎与这些患者进行讨论，但不能排除最初的期望管理权。 版权所有©2023年欧洲泌尿外科协会。由Elsevier B.V.发表。保留所有权利。

Family history (FH) of prostate cancer (PCa) is associated with an increased risk of PCa and adverse disease features. However, whether patients with localized PCa and FH could be considered for active surveillance (AS) remains controversial.To assess the association between FH and reclassification of AS candidates, and to define predictors of adverse outcomes in men with positive FH.Overall, 656 patients with grade group (GG) 1 PCa included in an AS protocol at a single institution were identified.Kaplan-Meier analyses assessed the time to reclassification (GG ≥2 and GG ≥3 at follow-up biopsies) overall and according to FH status. Multivariable Cox regression tested the impact of FH on reclassification and identified the predictors among men with FH. Men treated with delayed radical prostatectomy (n = 197) or external-beam radiation therapy (n = 64) were identified, and the impact of FH on oncologic outcomes was assessed.Overall, 119 men (18%) had FH. The median follow-up was 54 mo (interquartile range 29-84 mo), and 264 patients experienced reclassification. The 5-yr reclassification-free survival rate was 39% versus 57% for FH versus no FH (p = 0.006), and FH was associated with reclassification to GG ≥2 (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.19-2.15, p = 0.002). In men with FH, the strongest predictors of reclassification were prostate-specific antigen (PSA) density (PSAD), high-volume GG 1 (≥33% of cores involved or ≥50% of any core involved), and suspicious magnetic resonance imaging (MRI) of the prostate (HRs 2.87, 3.04, and 3.87, respectively; all p < 0.05). No association between FH, adverse pathologic features, and biochemical recurrence was observed (all p > 0.05).Patients with FH on AS are at an increased risk of reclassification. Negative MRI, low disease volume, and low PSAD identify men with FH and a low risk of reclassification. Nonetheless, sample size and wide CIs entail caution in drawing conclusions based on these results.We tested the impact of family history in men on active surveillance for localized prostate cancer. A significant risk of reclassification, but not adverse oncologic outcomes after deferred treatment, prompts the need for cautious discussion with these patients, without precluding initial expectant management.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.