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Paul Edwards

Prostate cancer in the family

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Paul Edwards

The Chairman of our monthly teleconferences is retired radiation oncologist, Dr Bruce Kynaston.

We are grateful to Bruce and the Prostate Cancer Foundation of Australia for permission to reproduce this article which appeared in the May 2014 issue of the Queensland Prostate Cancer News

 

Prostate cancer in the family

Bruce Kynaston reports on the significance of acting on a family history of prostate or breast cancer. 

 

During 2013, Angelina Jolie had both her breasts excised because of a family history of that problem; tests had shown mutation in one of her BRCA1 and 2 genes. 

 

We all have two BRCA genes, but hopefully ones that have not altered.  Actually, it is only BRCA2 gene mutation that applies to prostate cancer risk.  Gene mutation occurs occasionally and usually some property that the gene controls is lost, so resulting problems can arise. 

 

Sometimes family cancer histories are not easily traced.  Friends of mine have two sons aged in their 50s who have each been diagnosed with prostate cancer.  Neither parent has suffered prostate or breast cancer, but it is possible that a gene mutation occurred in the germ cells of either parent and passed to their sons.  I suggested they could contemplate having the check for BRCA gene mutation, as such information would be important for the children of these men. 

 

A recent notable medical paper addresses such issues: Germline BRCA Mutations are associated with Higher Risk of Nodal Involvement, Distant Metastasis, and Poor Survival Outcomes in Prostate Cancer (Elena Castro and others, 2013, JClinOncol 31:1748-17 5 7.) 

 

This paper shows that:

  • 2019 patients with prostate cancer were eligible for the trial, of whom 79 were BRCA carriers–but only one had a BRCA 1 mutation.
  • 16 per cent of the patients were 65 years at diagnosis, and 34 per cent had a family history of prostate cancer.
  • Prostate cancer was mainly diagnosed as a result of clinical symptoms.
  • The proportion of BRCA carriers diagnosed through PSA screening was significantly higher compared with non-carriers. 

Its results suggest why the words in the title are perhaps not a true reflection on modern earlier diagnosis–before ‘higher risk of nodal involvement, distant metastasis, and poor survival outcomes in prostate cancer’ would be expected.  Other research sources show that only the BRCA2 gene mutation appears to be the one that is related to prostate cancer. 

 

In essence then, a family history of prostate or breast cancer may be relevant, especially if there are many cases, and genetic testing may be warranted. 

 

Don’t rely on Internet sites that offer such tests.  The recommended approach is to call Cancer Council Helpline 131120 and explain why you have called.  All of the various States’ Cancer Council Helplines have access to identical information.  If you have a referral from a GP, and if there is uncertainty as to where to go next, return to the Helpline (with your referral) and ask for direction.”

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