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Prominent scientists are advocating for annual prostate cancer Screening for men with BRCA1 and BRCA2 gene mutations.
London based expert Institute of Cancer Research (ICR) Explain that the significantly increased risk for these individuals justifies such preventive tests.
The ICR team has focused on identifying them most susceptible to diseaseSo that candidates can be exposed for targeted examinations.
The recommendation comes as the UK National Screening Committee reviews the evidence for a comprehensive prostate cancer screening programme, pushing for annual tests for all men or those at highest risk.
Currently, there is no national screening program due to concerns that the prostate specific antigen (PSA) test is not reliable enough and could lead men to undergo invasive tests and be treated for cancers that would not harm them.
However, it is known that BRCA gene mutations are associated with a greater chance of developing prostate cancer at a younger age and in a more aggressive form.
For example, 21 to 35 out of 100 men with the BRCA2 variant will develop prostate cancer before age 80, research has found.
In 2019, the ICR team said that men with BRCA2 mutations have such a high risk of aggressive prostate cancer that they should be offered annual PSA testing.
Now, their latest study findings, presented at the European Society for Medical Oncology (ESMO) congress in Berlin, suggest that men with BRCA1 mutations should also be offered annual PSA testing.
Impact studies, which are funded cancer research ukICR and others assessed the potential benefits of PSA testing in men with BRCA1 and BRCA2 mutations at 65 centers in 20 different countries around the world.
It found that men with a BRCA1 genetic defect were more than three times as likely to develop aggressive prostate cancer than those without the defect.
The study found that there was no difference in the age at diagnosis, or the risk of developing prostate cancer, for BRCA1 carriers compared to non-carriers.
The new results also indicate that the risk of prostate cancer among BRCA2 carriers is more than double that of non-carriers, from 1.4% to 3.1%.
Meanwhile, the average age of diagnosis for carriers is 60 years, while for non-carriers it is 65.
The ICR team said that while more accurate prostate cancer tests – such as saliva tests to detect genetic risk of cancer – are being tested, targeted screening using the PSA test for those at highest risk could significantly improve early detection of the disease.
Scientists are also calling for the guidance to be updated so that both BRCA1 and BRCA2 carriers can receive annual PSA testing.
Ross Eales, Professor of Oncogenetics at the ICR, who led the study, said: “Our research shows that men with BRCA1 and BRCA2 mutations have a significantly higher risk of aggressive prostate cancer.
“Until more accurate diagnostic tests become available, targeted PSA screening in this high-risk group may detect these cancers earlier, when treatment is more effective.
“We are urging regulatory bodies to act on the evidence and update current guidance to offer annual PSA testing to all men aged 40 who have a BRCA1 or BRCA2 mutation.
“We are expecting an update to this guidance soon, and we look forward to including BRCA carriers in any targeted screening programs to give these people more control over their health and improve timely diagnosis.”
The study followed more than 3,000 men who were offered annual PSA testing for five years.
When looking at more widespread population screening, scientists and donors appear to be divided on the issue.
Evidence suggests that PSA levels can increase for a variety of reasons, including simple infections, and 75% of people with an elevated PSA do not have prostate cancer.
Raised levels may mean men are referred for unnecessary biopsies or MRIs, or sent for treatment for tumors that may never cause harm.
PSA testing may also miss invasive cancers. Evidence suggests that about 15% of people with normal results may actually have prostate cancer.
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said: “These exciting findings confirm that annual PSA blood testing will enable men with BRCA gene variants to detect aggressive prostate cancer at an earlier, treatable stage. This is important evidence that men at highest risk of this disease will benefit from screening.
“Three years ago, Prostate Cancer UK submitted evidence to the UK National Screening Committee, which made the case for screening men with a family history of prostate cancer and black men – we await their decision.
“We are proud that Prostate Cancer UK has funded Professor Eales’ work for many years – and he is now one of the lead researchers on our £42m TRANSFORM screening trial, which will find the missing evidence and new tests needed to create a safe and effective screening program for all men.”