Men born with a genetically high risk of developing prostate cancer ‘should have a blood test every year from the age of 40’

• Men may carry the BRCA2 gene, a mutation that also causes breast cancer
• Those men should be identified and given blood tests every year, scientists say
• Their study found men with the faulty gene were diagnosed at an earlier age 

Men with a genetically high risk of developing prostate cancer should be given extra checks every year after they turn 40, scientists say.    

One in four men who carry a fault in their DNA – a mutation on the BRCA2 gene – will develop the killer disease at some point in their life.

Around one in 300 men in the UK have the mutation, which is similar to the BRCA-1 gene fault carried by Angelina Jolie. But most will not know because it is not routinely tested for. 

Researchers now say if all of those men could be identified, they should be given an annual blood test to detect tumours early.

In a study, men with the BRCA2 gene fault who had a blood test were diagnosed at a younger age – an average of 61 years, compared with 64.

Men with a genetic risk of developing prostate cancer should be given extra checks every year after they turn 40, scientists at the Institute of Cancer Research say

Experts at the Institute of Cancer Research (ICR), London, said men with the mutated BRCA2 gene should be checked for elevated prostate-specific antigen (PSA) every year.

Prostate-specific antigen (PSA), a protein made only by the prostate gland, goes up in people with prostate cancers.

But PSA levels are not deemed a reliable method of screening the general population – only those at risk. 

The ICR’s study assessed the potential benefits of PSA testing in men with BRCA2 mutations at 65 centres in 20 different countries around the world. 

PSA testing picked up prostate cancers more often, at a younger age and in more dangerous forms in men with BRCA2 mutations than in non-carriers. 

Men with the BRCA2 gene fault were almost twice as likely to be diagnosed with prostate cancer as non-carriers, the scientists said.

Crucially, men with the BRCA2 gene fault more often had serious, potentially life-threatening tumours.

Professor Ros Eeles, who led the study, said: ‘We’re now calling on regulatory bodies to update guidance so men with BRCA2 defects can get regular PSA screening.

‘Every man over the age of 40 who carries a mutation in the BRCA2 gene should be offered an annual PSA test.’

The BRCA2 gene fault is usually associated with breast and ovarian cancer in women – with those who carry it having a 50 per cent to 85 per cent risk of developing breast cancer by age 70.

Men may be tested for BRCA2 if such cancers run in the family, with results available within a month. But this isn’t available everywhere in the UK. 

At the moment there’s not enough evidence to say whether or not being tested for mutations should be done, even in men with a family history of cancer. 

The PSA test is controversial because it can miss prostate cancer – one in seven men with a normal PSA level may have prostate cancer. 

But some men may be forced to go through more tests, such as a biopsy, because of a false positive result.

Prostate Cancer UK said decisions about whether to offer at-risk men blood tests every year should be thought about carefully. 

Dr Matthew Hobbs, deputy director of research for the charity, said: ‘[We are] funding a project to model the long-term effectiveness of a range of potential screening strategies, including defining whether there are certain high-risk groups for whom the benefits of regular screening greatly outweighs the potential for overtreatment.

‘It may be that screening all men with a BRCA2 mutation could be one of the answers, so we will look carefully at the results of this study.’

The European Association of Urology’s guidelines committee will now be considering the ICR’s evidence, which was presented at the 2019 NCRI Cancer Conference in Glasgow.

Prostate cancer is the most common cancer for men with almost 48,000 diagnoses a year in the UK and more than 1.2million worldwide.

WHAT IS PROSTATE CANCER? 

Prostate cancer is the growth of tumours in the prostate gland.

Only men have a prostate, which is a walnut-sized gland between the rectum and the penis which creates a fluid to be mixed with sperm to create semen. 

How many people does it kill? 

More than 11,800 men a year – or one every 45 minutes – are now killed by prostate cancer in Britain, compared with about 11,400 women dying of breast cancer.

It means prostate cancer is behind only lung and bowel in terms of how many people it kills in Britain. In the US, the disease kills 26,000 each year.

Despite this, it receives less than half the research funding of breast cancer – while treatments for the disease are trailing at least a decade behind.

How quickly does it develop? 

Prostate cancer usually develops slowly, so there may be no signs someone has it for many years, according to the NHS. 

If the cancer is at an early stage and not causing symptoms, a policy of ‘watchful waiting’ or ‘active surveillance’ may be adopted. 

Some patients can be cured if the disease is treated in the early stages.

But if it diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms.

Thousands of men are put off seeking a diagnosis because of the known side effects from treatment, including erectile dysfunction.

Tests and treatment

Tests for prostate cancer are haphazard, with accurate tools only just beginning to emerge. 

There is no national prostate screening programme as for years the tests have been too inaccurate.

Doctors struggle to distinguish between aggressive and less serious tumours, making it hard to decide on treatment.

Men over 50 are eligible for a ‘PSA’ blood test which gives doctors a rough idea of whether a patient is at risk.

But it is unreliable. Patients who get a positive result are usually given a biopsy which is also not foolproof. 

Scientists are unsure as to what causes prostate cancer, but age, obesity and a lack of exercise are known risks. 

Anyone with any concerns can speak to Prostate Cancer UK’s specialist nurses on 0800 074 8383 or visit prostatecanceruk.org.

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