Tuesday, 21 May 2013

BRCA2 and the good news that got lost in the headlines


This weekend the papers reported that a man – who carried the faulty BRCA2 gene – had undergone surgery to remove his prostate as a form of preventative treatment for prostate cancer. The articles published in the Sunday Times and Daily Mail – which follows the news that Angelina Jolie had preventative surgery for breast cancer – stated this man was the first in the world to go through such a procedure.

Strictly speaking, and although it ruins a good news story, this is not true. This gentleman had early signs of malignancy in his biopsy results, so wasn’t cancer free. He used the information that he carried the BRCA2 gene as a decision maker to choose which treatment to have. The world is still to see a preventative prostatectomy, and with the evidence as it stands, I hope it stays that way.

There is currently little (if any) information or research on the effect of preventative prostatectomy for prostate cancer and we don’t know enough about the clinical outcomes. Removal of the prostate can lead to serious (and long term) side effects, including erectile dysfunction and incontinence. Put simply, there’s no data whatsoever on whether carrying out this surgery will improve survival rates or men’s quality of life. It’s also worth remembering that many men develop prostate cancer because of other factors other than carrying the BRCA2 gene. In fact, only five to 10 per cent of prostate cancers are thought to be strongly linked to inherited risk.

Last month I wrote about new research from the ICR that linked BRCA2 with aggressive prostate cancer and the need for treatment. It was through taking part in a similar study that the man in question found out he carried this faulty gene. This research is important and could lead to advances that help men with prostate cancer, but not through preventative surgery at this stage.

Through all this discussion around preventative surgery, it’s easy for the good news to get lost: identifying the link between the BRCA2 gene and aggressive prostate cancer is a great step forward for men’s health. In the short term, we can offer men with this faulty gene genetic counselling and frequently screen them for any sign of prostate cancer. In the long term, and with further research, we could be in the position to tell aggressive from non-aggressive prostate cancer in a simple and effective way. Now there’s a newsworthy story.

2 comments:

  1. I would love a preventative for prostate cancer as my father-in-law, brother-in-law have had prostate cancer, and my husband has recently been diagnosed with prostate cancer. Both my husband and brother-in-law were both just under 50 when they were diagnosed. there are 6 boys from the family that will need to be tested and I think it should be done at a younger age, rather than wait until they are 40-50yrs old. So a preventative would help many men, rather than go through the stress our family have gone/going through.

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  2. To suggest this case followed established protocal is wrong. Why did he have the biopsy in the first place? His PSA level was normal and the malignancies at that stage wouldn't have shown up in the in the DRE. He only had the biopsy because he was conerned about the BRCA2 mutation. Regular screening as suggested in the blog post would have done nothing for him. After the surgery they found additional cancerous cells that never even showed up in the biopsy. Screening for prostate cancer has been shown to be innefective because once-detected aggressive cancers still advance and once-detecteed non-aggressive cancers aren't threatening. My dad has BRCA2 and was diagnosed with advanced aggressive metastatic prostate cancer without his PSA ever going above 0.5. True understanding of how BRCA2 affects men is only beginning to be understood and unfortunately the result looks like it is as devastating for men due to prostate cancer as it is for women due to breast/ovarian cancer. For women preventative surgery is the well established approach, not watchful waiting. As we continue to better understand BRCA2 in men its hard to see why we won't come to the same conclusion.

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