Men over 40 with faulty BRCA2 gene should be tested annually for prostate cancer

Scientists at The Institute of Cancer Research, London, are calling for annual blood tests to detect aggressive prostate cancer in men who have a fault in the BRCA2 gene. After researching the effectiveness of the test, Ros Eeles, who led the study, said: “Our research shows very clearly that men with the BRCA2 gene fault are at increased risk of aggressive prostate cancer and that regular PSA testing could go some way to improving early diagnosis and treatment.”

The PSA test is done using a small amount of blood to detect raised levels of prostate specific antigen (PSA). Yet, despite its relatively low cost and ease of administering, it is not offered for routine screening in many countries, including the UK. This is because a significant proportion of those testing positive have no disease (a false-positive result), slow-growing cancer that doesn’t need treatment, or positive results caused by a relatively benign condition, such as a urinary tract infection.
Detecting prostate cancer early is important and saves lives. But many of those identified by the PSA test as having elevated levels of the antigen could potentially undergo painful treatment with significant life-altering side effects, which were unnecessary. Also, up to 15% of men with prostate cancer have normal PSA levels (a false-negative result), meaning that many men would receive unwarranted reassurance from this test.

Guidelines in most countries, therefore, note that the possible benefits of testing are outweighed by the potential harms of over-diagnosis and over-treatment, making it unsuitable for screening everyone.

Faulty BRCA2 gene

Men with faults in their BRCA2 gene are, however, five times more likely to be diagnosed with prostate cancer and at a younger age. More worryingly, this high-risk group is also twice as likely to have a more serious, potentially life-threatening, form of prostate cancer.

Faults in the BRCA2 gene are more commonly linked to breast cancer, and this is where it gets its name (BReast CAncer). The gene itself was originally identified by looking at families and groups that showed higher than normal levels of breast cancer. This includes people of Icelandic, Scottish, Northern Irish, Quebecois and Ashkenazi Jewish origin, where specific faults in the BRCA2 gene are seen.

In both these families and groups, researchers also identified higher than normal levels of male breast cancer (yes, men can also get breast cancer), prostate, pancreatic and other cancers.

BizCommunity by Michael Porter, 8 November 2019 (https://www.bizcommunity.com/Article/196/335/197708.html)