How to cite: Kovac E. Influence of Family History, Race, and Genetic Markers on Prostate Cancer Screening. Grand Rounds in Urology. October 23, 2025. Accessed Oct 2026. https://grandroundsinurology.com/influence-of-family-history-race-and-genetic-markers-on-prostate-cancer-screening/
Summary
Evan Kovac, MD, CM, FRCSC, Associate Professor and Director, Urologic Oncology, Rutgers University, Newark, New Jersey, examines how prostate cancer screening decisions are shaped by family history, race, and inherited genetic markers, with emphasis on individualized, risk-adapted screening rather than uniform population approaches. He frames the discussion around changes in prostate-specific antigen (PSA) screening recommendations and the clinical consequences that followed.
Dr. Kovac reviews how earlier recommendations against routine prostate-specific antigen screening altered screening behavior, followed by updated guidelines emphasizing shared decision-making. He describes concerns raised about later-stage disease at diagnosis and how these concerns renewed focus on identifying higher-risk individuals who may benefit from earlier or more intensive screening.
Presenting family history as a central risk modifier, Dr. Kovac explains which factors may increase prostate cancer risk. He emphasizes that family history is often captured incompletely in clinical practice and should be reassessed over time, as it directly informs screening discussions and timing.
Race is discussed in relation to differences in prostate cancer incidence and mortality. Dr. Kovac notes higher risk and worse outcomes described in Black men and highlights the importance of addressing screening access, bias, and trust. Screening is presented as one component of a broader effort to reduce disparities, rather than a standalone solution.
Addressing inherited genetic markers, which are an evolving factor in screening decisions, Dr. Kovac discusses germline testing and how certain mutations influence counseling, screening initiation, and follow-up intensity. Case-based examples illustrate how genetic risk may alter conventional screening approaches
Dr. Kovac acknowledges baseline PSA as a tool for long-term risk stratification. He highlights practical considerations for implementing risk-adapted screening, such as the use of decision aids and community-focused outreach, to support informed decision-making in higher-risk populations.
About the 28th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, Richard G. Stock, MD, and William K. Oh, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques.
ABOUT THE AUTHOR
Evan Kovac, MD, CM, FRCSC, is an Associate Professor and Director of Urologic Oncology at Rutgers University in Newark, New Jersey. Dr. Kovac also serves as the Associate Program Director of the Urology Residency at Rutgers University. He specializes in the evaluation and treatment of cancers of the urinary tract, including prostate, kidney, bladder, testicular, adrenal and penile cancers. Dr. Kovac has specific expertise in ultrasound-MRI fusion biopsy for the diagnosis of prostate cancer, as well as, endoscopic and robotic surgery techniques for the treatment of genitourinary cancers.
Dr. Kovac earned his medical degree and completed a residency in Urology at McGill University in Montreal, Canada. He then completed a fellowship in Urologic Oncology and Robotics at the Cleveland Clinic in Cleveland, Ohio. Dr. Kovac is a Fellow of the Royal College of Surgeons of Canada.
Dr. Kovac has authored and co-authored over 60 publications and book chapters on urologic oncology. He is considered a leader in the optimization of prostate-specific antigen screening for the early detection of prostate cancer. Dr. Kovac led a collaboration with primary care physicians to create a novel prostate cancer screening decision aid designed specifically for multi-ethnic, underserved communities. He also led the establishment of a first-of-its-kind prostate cancer center in the Bronx, New York.
