“Those who cannot remember the past are condemned to repeat it,” said the 20th century philosopher George Santayana. Though he wasn’t referring family heredity, we might rephrase his words as follows: Those who ignore a family history of cancer are condemned to a higher risk of developing it. That’s because cancer has many genetic properties that can be handed down from one generation to the next. While that may sound like doom and gloom, it’s worth it to learn your family’s health history—and then take certain precautions if cancer is part of it.

Do you have a dangerous gene variant?

For men, national organizations like the American Cancer Society and the Prostate Cancer Foundation continually inform men with a blood relative who had PCa (e.g. ancestor, uncle, brother, etc.) are at risk for this cancer. Just as important, certain inheritable breast cancer germline (genetic) variants called BRCA 1 and BRCA 2 also raise chances for PCa^[i] According to the Breast Cancer Foundation, about 1 in 20 men carry a BRCA1/2 inherited mutation. The National Cancer Institute states, “Men with BRCA2 variants, and to a lesser extent BRCA1 variants, are also at increased risk of breast cancer and prostate cancer.”

If you have a family lineage of prostate, breast or any other cancer, how can you find out if you have a dangerous gene? The answer is genetic testing, something you should discuss with your doctor. There are different types of tests and testing may be covered by insurance. Your doctor can help with this.

What if my test indicates higher PCa risk?

Don’t panic if you have a test that comes back positive for PCa risk. A new study brings good news that multiparametric MRI (mpMRI) of the prostate is highly accurate for monitoring men with certain germline mutations. The 2024 journal article presents results of a comparison between PSA vs. mpMRI screening for men with genetic risk factors.^[ii] The study involved 101 men, most of whom carried BRCA2 (44 men), BRCA1 (35 men), or a variant called ATM (7 men). Compared with PSA screening alone, mpMRI was highly accurate at predicting which men had a suspicious lesion that required a biopsy (and which did not, even if their PSA was elevated). A medical news article reported the numbers: “In this high-risk cohort, mpMRI showed 100% sensitivity and a 100% negative predictive value for prostate cancer detection on biopsy, whereas PSA-based screening alone had 57% sensitivity with a negative predictive value of 73%…”^[ii] (Sensitivity means correctly identifying individuals who are positive for a disease, and negative predictive value means correctly identifying those who don’t have it.)

In the words of the authors, “We found that in certain germline carriers of prostate cancer risk mutations, magnetic resonance imaging–based screening enhances detection of prostate cancer while reducing biopsies triggered, in comparison with traditional prostate-specific antigen screening strategies.”^[iv] To put it another way, if you carry a germline mutation that increases your chances for developing PCa, annual PSA testing is not reliable for early detection. However, having an mpMRI scan at intervals recommended by your doctor can accurately register an area with suspicion for clinically significant disease that should be biopsied.

The authors acknowledge that the cost of too-frequent mpMRI scans may sound prohibitive for insurers, so determining timing for repeat scans could be complex. However, from the patient’s point of view, no cost is too high if a tumor that would otherwise be overlooked is identified early when it is still treatable with a high chance of cure. Instead, any PCa patient who carries a risky gene variant would only be grateful if mpMRI saved his life.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Lecarpentier J, Silvestri V, Kuchenbaecker KB, et al. Prediction of breast and prostate cancer risks in male BRCA1 and BRCA2 mutation carriers using polygenic risk scores. J Clin Oncol. 35(20):2240-2250, 2017
[ii] Amini AE, Hunter AE, Almashad A, Feng AJ et al. Magnetic Resonance Imaging-based Prostate Cancer Screening in Carriers of Pathogenic Germline Mutations: Interim Results from the Initial Screening Round of the Prostate Cancer Genetic Risk Evaluation and Screening Study. Eur Urol Oncol. 2024 Mar 6:S2588-9311(24)00041-5.
[iii] Persaud, N. “MRI Screening Detects Prostate Cancer Among Men with Germline Mutations.” Renal&Urology News, Mar. 29, 2024. https://www.renalandurologynews.com/news/urology/prostate-cancer/mri-screening detects-prostate-cancer-among-men-with-germline-mutations/
[iv] Amini et al., ibid.