A study performed in the UK, reported in the British Journal Cancer (2010), showed that men who have a deleterious germ-line mutation in the breast cancer 2 (BRCA2) gene and who have prostate cancer do not survive as long as men with prostate cancer who are non-carriers.

There have been earlier studies that have shown a link between BRCA2 mutations and the overall risk for prostate cancer, and more recently the gene has been associated with a susceptibility to aggressive prostate cancer.

Rosalind Eeles from the Institute of Cancer Research in Sutton, and colleagues, who reported this study, believe their finding of shorter survival among men with the BRCA2 mutation has implications for the detection and management of prostate cancer.

The researchers evaluated survival rates from UK cancer registries in two groups of men with prostate cancer:

1) The first group contained young-onset (aged 55 years or less) prostate cancer patients (n=263), 2.3% of whom carried the BRCA2 mutation. The second group (n=15) all carried BRCA2 mutations and acted as a control group.

2) The median overall survival duration was significantly shorter among BRCA2 mutation carriers than among non-carriers, at 4.8 years versus 8.5 years, giving a 2.14-fold increased risk for prostate cancer-specific mortality among carriers of the mutation.

Multivariate analysis, adjusted for factors including age and stage at diagnosis and whether the men had undergone surgery confirmed the BRCA2 mutation as an independent predictor of poor survival, with a hazard ratio of 7.54 for death among carriers during the study period.

Disease T stage, nodal status, and higher grade were also confirmed as independent prognostic risk factors for reduced survival.

The research team questioned, “whether earlier detection of prostate cancer in men with germ-line mutations in BRCA2 will result in better outcome and whether PSA screening is suitable for such a population.”

The researchers also concluded that the “poorer survival” would be a contraindication for active surveillance” for newly diagnosed men with the mutation.

To take the question even further, the advanced prostate cancer blog asks if, as in breast cancer, the consumption of estrogen rich products and estrogen ADT therapy should be actively avoided for men with the mutation?

Genetic screening is often encouraged and performed in breast cancer survivors. Perhaps a similar attitude should exist for men with advanced prostate cancer.

Joel T. Nowak, M.A., M.S.W.