Over the last few years, a number of studies have suggested that men with germline BRCA mutations (especially BRCA2) have poorer outcomes when they develop prostate cancer. In fact, a recent study of 2019 patients with prostate cancer, including 18 BRCA1 carriers, 61 BRCA2 carriers, and 1940 noncarriers indicated that germline mutations were more frequently associated with: higher Gleason score, later stage (T3/T4), nodal involvement, and metastatic disease present at diagnosis. Thus, these findings suggest that when men with BRCA mutations develop prostate cancer, it is more likely to be an aggressive subtype of the disease which may be related to the poorer outcomes observed. Consequently, study authors suggested that consideration should be given for tailoring clinical management for these patients, especially because most BRCA carriers with prostate cancer are currently treated through following the same protocols used for noncarriers (due to lack of studies focused on evaluating tailored management strategies in this group of men).
Furthermore, although clinical trials in this group are needed, authors suggested the following as a consideration: “radical treatment with either surgery or radiotherapy seems to be preferable to active surveillance for these patients, even for cases classified as low risk.”
Castro et al. J Clin Oncol. 2013 May 10;31(14):1748-57.