ProstateGene

Prostate cancer is the most common cancer among men in the UK. Unfortunately, 1 in 6 men will be diagnosed with prostate cancer, with 75% being diagnosed over the age of 65. The majority of prostate cancer occurs by chance however approximately 5-9% of all prostate cancer and 12% of metastatic prostate cancer is estimated to be hereditary.
Prostate cancer is very common in older men, is frequently slow growing and even untreated would often not shorten a man’s life. However, in some men prostate cancer is more aggressive and develops faster, in these situations early diagnosis and treatment will save lives. In some families, with hereditary prostate cancer, it may be possible to find the genetic change (pathogenic variant) which is responsible for the cancers thereby allowing appropriate cancer screening. In general, men with one first degree relative (father or brother) have twice the risk of prostate cancer, while men with two first degree relatives have five times the risk compared to the general population.

You may be at risk of hereditary prostate cancer if you or a close relative (brother, father or son) have prostate cancer AND any of the following signs:

• Early onset prostate cancer (diagnosed before age 55)
• Metastatic prostate cancer
• Ashkenazi Jewish ancestry
• Two relatives with breast or ovarian cancer
• One relative with male breast cancer or ovarian cancer or bilateral breast cancer
• One relative with early onset bowel or womb cancer (before 50)
• Two relatives with bowel or womb cancer

Genetic testing can help determine the cause of the prostate cancer and may suggest particular cancer treatment, in particular chemotherapy. Genetic testing can also determine the risk of cancer within a family and guide appropriate cancer screening. Depending on the specific genetic risk different screening tests can be arranged and risk-reducing strategies can be considered.

The following genes have been shown to be associated with prostate cancer and are tested as part of ProstateGene:

• ATM
• BRCA1
• BRCA2
• CHEK2
• EPCAM
• HOXB13
• MLH1
• MSH2
• MSH6

There are three possible results:

1. A pathogenic variant is found in one of the genes which is known to increase the risk of prostate cancer. Different chemotherapy may be indicated. Increased screening and/or risk- reducing techniques will be recommended.
2. A genetic variant of uncertain significance (VUS) is found, but whether this is the cause of cancer is unknown. Screening will be recommended based on the family history.
3. No variant is found. It is possible that there may be an undetectable variant or a variant in a different gene. Cancer screening may still be beneficial.

If you have a pathogenic variant this explains the diagnosis of prostate cancer in yourself or your family and may mean you have an increased risk of other cancers. Your exact risks will depend on which gene variant has been found. Extra screening and/or risk-reducing strategies will be discussed. It will also be possible to offer predictive testing to other people in your family to see if they also have a pathogenic variant

Prostate cancer screening aims to diagnose prostate cancers at an earlier, more treatable stage, although however, screening for prostate cancer is still imprecise and, in some situations, may lead to unnecessary biopsies or false reassurance. However, annual PSA testing is recommended from age 40-69 for men with a high risk of prostate cancer. A cut off 3ng/ml should be used to suggest a biopsy.

Screening for other cancers may also be needed and will be discussed if necessary.

It is important for all men to be prostate aware and inform their doctor if they notice any signs that they are concerned about.

Signs of prostate cancer include;

• Needing to urinate often, especially at night
• Difficulty in starting to urinate
• Straining to urinate or taking a long time to finish
• Pain when urinating or ejaculating
• Pain in the lower back, hips or pelvis
• Blood in the urine.

Most men with these signs will not have cancer but is always important to get them checked out.

It is known that ethnicity influences the risk of prostate cancer: black men have the highest risk of prostate cancer, then white men and Asian men have the lowest risk.

Height is also associated with prostate cancer: the taller a man the higher his risk.

A personal history of some types of cancer (kidney, bladder, melanoma, lung, thyroid) also increases the risk of prostate cancer as does exposure to radiation.

Warfarin, Acetaminophen and diabetes have been shown to lower the risk of prostate cancer.

Some individuals may be concerned about difficulties obtaining insurance coverage following predictive genetic testing for healthy individuals. This does not need to be a concern if testing is predictive as the Code on Genetic Testing and Insurance ensures that individuals do not have to disclose cancer predictive test results. For individuals diagnosed with cancer, it is unfortunately likely that they will find it difficult to take out life insurance. More information can be found here.