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BRCA mutations may increase risk for prostate cancer
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Prostate cancer rates appeared significantly higher among men who harbored BRCA1 and BRCA2 mutations than the general public, according to results of a prospective study presented at the American Urological Association Annual Meeting.
Although germline BRCA mutations in men increase risk for prostate cancer, no cancer screening guidelines are available for this patient population.
Between February 2014 and July 2016, David Margel, MD, urologist at Rabin Medical Center in Petah Tikva, Israel, and colleagues analyzed 154 known male BRCA mutation carriers (median age at enrollment, 50 years; interquartile range [IQR], 42-63) to identify cancer rate and type. All men had a family history of cancer of 1 to 10 cases per family.
All men aged 40 years and older underwent screening for prostate, breast, colorectal, pancreatic and skin cancers.
Ninety men (60%) had BRCA1 mutations, 61 (40%) had BRCA2 mutations and one had both. The most common mutations included 185delAG in BRCA1 (74%) and 6174delIT in BRCA2 (82%).
At the time of enrollment or initial screening, 24 patients (16%) had cancer (median age at diagnosis, 55 years; IQR, 44-64). Seven of 93 patients with BRCA1 mutations (8%) and three of 62 patients with BRCA2 mutations (5%) had prostate cancer. Four patients had multiple malignancies (2-4 cases per patient).
Prostatic adenocarcinoma occurred most frequently — among seven patients with BRCA1 mutations and three patients with BRCA2 mutations.
“Malignancy rates in male BRCA mutation carriers are substantially higher than those reported for the general population in corresponding age groups,” the researchers wrote. “Unlike other reports, prostate cancer was prevalent among BRCA1 carriers and not restricted to BRCA2.” – by Melinda Stevens
Reference:
Margel D, et al. Abstract PD07-10. Presented at: American Urological Association Annual Meeting; May 12-16, 2017; Boston.
Disclosures: HemOnc Today could not confirm relevant financial disclosures at the time of publication.
Perspective
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Eric Klein, MD
This is an important observation and something that the community of physicians who thinks about genetic risk and prostate cancer is well aware of and actually has considered in some detail. It is known that BRCA carriers are at higher likelihood of getting malignancies and men who are BRCA carriers are much more likely to get prostate cancer.
What’s really important, although this study didn’t address it, is that BRCA–associated prostate cancers, and especially BRCA2–associated prostate cancers, are very aggressive and among the most aggressive prostate cancers that we see. This kind of information is critical for education of populations of patients who are known to have BRCA carriers in their family. We talk to men in the clinic about this all the time. It has been fascinating to see how our ability to sequence DNA and how the power of technology has allowed us with every passing year to sequence more completely, and find more genes that are highly clinical relevant to individuals at risk.
There are no standard screening guidelines yet for patients who are known to be BRCA carriers. In the short term, the importance of this study is to use it to educate primary care providers and the public that these are important mutations and our ability to find these types of mutations improves ever year. Patients with a strong history of breast or ovarian cancer in the family should ask their doctors about it. There are genetic screening panels that are easily available to identify those at risk.
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