Originally published 11/27/2014
Nearly a decade has passed since we posted the blog below. The two breast cancer genes (BRCA1, BRCA2) continue to be potentially deadly culprits for men who carry these two genetic variants. However, there are 17 other less common variants also linked with PCa risk.
In 2020, a research team from Massachusetts General Hospital launched a 20-year study, The Prostate Cancer Genetic Risk Evaluation and Screening Study (PROGRESS). They seek to test the benefits of screening men genetic risk factors using multiparametric MRI (mpMRI). In March, 2024 they published their initial findings based on 101 enrollees, reporting that, “Of six screening strategies evaluated in the decision curve analysis, MRI based screening alone achieved superior net benefit at all threshold probabilities compared with PSA.”
Their conclusion states that for men carrying certain genomic mutations, especially BRCA2, BRCA1 and ATM, “… magnetic resonance imaging–based screening enhances detection of prostate cancer while reducing biopsies triggered, in comparison with traditional prostate-specific antigen screening strategies.”[i]
The study is expected to complete in Dec. 2040, but stay tuned for interim findings that confirm what we posted almost 10 years earlier.
In the world of women’s health, word about new tests and treatments gets out quickly. Countless women know about two gene mutations, BRCA1 and BRCA2, because of actress Angelina Jolie’s choice to have both breasts removed. When these two genes function normally, they help to make sure cells don’t proliferate out of control. However, certain mutations can dramatically raise breast cancer risk. In Ms. Jolie’s case, she tested positive for the BRCA1 mutation. After her surgery and breast reconstruction, she told the press that her cancer risk went from 87% to 5%.
In the world of men’s health, news about personal wellness concerns tends to spread more slowly. Sometimes, it seems it creeps along at a snail’s pace. I thought I would do my share to help get the word out about how those two genetic mutations actually increase a man’s risk for prostate cancer.
While the exact cellular and molecular mechanisms are not yet completely understood, research shows that men who carry either mutation of BRCA1 or BRCA2, or both, are at greater risk of developing prostate cancer—as much as 8% increase—than men who don’t. More importantly, if they develop the disease, it is likely to be dangerously aggressive and potentially deadly. Men whose female family members have had breast cancer should consider being tested to learn if they carry either mutation.
What if the test proves positive? There is no established guideline regarding further screening or monitoring. However, many international oncologists, urologists and general practitioners recognize the value of multiparametric MRI in addition to routine tests such as PSA and DRE. Two currently running international clinical trials (one in Canada, the other in Israel) are designed to explore the value of more intensive screening, including multiparametric MRI of the prostate, for men who carry the mutations but have no symptoms of prostate cancer. The idea is to catch it early when an aggressive treatment is most likely to succeed.
Our Center is ideally set up to aid in multiparametric MRI as a screening adjunct to genetic testing for BRCA1 and BRCA2. If you have a family history of either prostate or breast cancer, I encourage you to speak with your doctor about testing for these genetic mutations. It could be a lifesaver.
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] 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.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
