While prostate cancer can be so slow to develop in some men that it never affects their wellbeing at all, for others the health concern can be a real killer. Up to now, there is no way to identify those whose wellness is at a high risk of dying from the disease, but scientists believe they have come one step closer. This breakthrough, which comes from the Institute of Cancer Research in London, means that we could soon have genetic tests that can identify high-risk men with prostate cancer – enabling them to be monitored throughout their lives – and other men who can avoid unnecessary treatment.
Award-winning wellness writer Sarah Boseley explains, ‘In some men, prostate cancer is so slow-growing that it will not cause them any harm in their lifetime – they will die with it, rather than of it. But in others, it is aggressive and a killer. Because side-effects of treatment can include impotence and incontinence, it has long been recognised that there is a need for tests to establish which men are in real danger and which are not.’ The researchers screened men from families with a history of prostate cancer, and, as a result have established that 14 mutations in known cancer genes can predict life-threatening disease. The investigators, who published their findings in the British Journal of Cancer, also found that men with these mutations were likely to have more aggressive disease.
Study co-leader Ros Eeles, professor of oncogenics at the Institute of Cancer Research and honorary consultant at the Royal Marsden NHS Foundation Trust, commented, ‘Our study shows the potential benefit of putting prostate cancer on a par with cancers such as breast cancer when it comes to genetic testing. Although ours was a small, first-stage study, we proved that testing for known cancer mutations can pick out men who are destined to have a more aggressive form of prostate cancer. We already have the technical capabilities to assess men for multiple mutations at once, so all that remains is for us to do further work to prove that picking up dangerous mutations early can save lives. If so, then in the future, genetic testing may be needed as part of the prostate cancer care pathway.’
As a result of these findings, doctors could screen men with prostate cancer in the family for their risk, much in the same way that doctors can now screen women for the BRCA1 and BRCA2 genes, which gives them a 50% chance of developing breast cancer. The 14 mutations which predict aggressive prostate cancer are in eight genes, which include BRCA1 and BRCA2. The others are ATM, CHEK2, BRIP1, MUTYH, PALB2 and PMS2. According to Dr Iain Frame, director of research at Prostate Cancer UK, ‘The minefield of prostate cancer diagnosis is one of the biggest hurdles facing treatment of the disease today. Current tests fail to differentiate between aggressive cancers that could go on to kill, and cancers that may never cause any harm.’
He continues, ‘This lack of clarity means that too often men and their doctors are left having to make incredibly difficult decisions on whether to treat the disease or not. We urgently need to understand more about which men are at risk of developing prostate cancer and in particular aggressive forms of the disease. Genetic testing to predict risk could revolutionise how we treat the 40,000 men diagnosed with the disease every year in the UK. These results are exciting as they add to the growing weight of evidence that men with a family history of prostate cancer who possess certain genes may be at higher risk, providing us with another crucial piece of the jigsaw.’