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ICARE Newsletter Summer 2014

Early Results to Suggest That PSA Screening May Help to Detect Prostate Cancer Early in Men with BRCA Mutations

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Over the last few years, there have been a number of studies to suggest that men with BRCA mutations, particularly BRCA2, have a higher risk of developing aggressive prostate cancer. It remains uncertain whether these men might benefit from screening through the prostate-specific antigen (PSA) test. Within the last few years, PSA screening guidelines in the United States were revised, and no longer recommend screening for all men in the general population.1 However, use of the PSA test in targeted screening for high risk men remains under active study. The initial results from an international study suggested PSA screening may be useful in detecting prostate cancer early among BRCA carriers.2  Specifically, the investigators recruited almost 2500 men, of whom 59 were subsequently diagnosed with prostate cancer (including 18 BRCA1 carriers and 24 BRCA2 carriers). Based on a PSA threshold of 3.0 ng/ml, almost half of BRCA2 carriers who had a biopsy were diagnosed with prostate cancer, which is much higher than the proportions reported when screening the general population for prostate cancer. Most of the men with a BRCA2 mutation who developed prostate cancer had intermediate- or high-risk disease, which is considered to be clinically important and requires treatment. These preliminary results suggest that targeted PSA screening in BRCA carriers may be useful to detect a high proportion of those who develop aggressive prostate cancer.

1.http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatefinalrs.htm2. Bancroft et al.Eur Urol. 2014 Jan 15. pii: S0302-2838(14)00004-9. PMID: 24484606

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