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May 23, 2013

Medical first: Man has prostatectomy after testing positive for BRCA gene

Daily Briefing

    A 53-year-old British businessman has undergone the first prophylactic prostatectomy after discovering that he carries the BRCA2 gene, which greatly enhances his risk of developing prostate cancer.

    The medical first comes on the heels of extensive media coverage of actress Angelina Jolie's decision to get a preventive double mastectomy after discovering she had the BRCA1 gene. Like Jolie, the British man—whose name has not been released—says he was keen to avoid the fate of family members who previously died from both breast and prostate cancer.

    Medscape Medical News reports that the man was participating in a clinical trial conducted by the Institute of Cancer Research (ICR) when he discovered the genetic mutation.

    Previous results from the trial have shown that men with the BRCA2 gene had a 8.6-fold increased risk of developing prostate cancer, while men with a BRCA1 gene has a 3.4-fold increased risk. Moreover, ICR researchers recently found that prostate cancer in men with a BRCA2 gene is highly aggressive and more likely to be fatal.

    Nonetheless, ICR researchers were initially reluctant to perform the prostatectomy at the man's request, noting that the procedure carries significant risks. Moreover, no cancer was detected in either prostate-specific antigen tests or MRIs. A biopsy did show microscopic malignant changes, however.

    In other men, the relatively low level of cancerous cells detected would not have prompted surgery, according to Roger Kirby of the Prostate Cancer Center in London, who performed the surgery.

    However, in an interview with the Sunday Times, Kirby said, "given what we now know about the nature of BRCA2, it was definitely the right thing to do for the patient." He compared life as a BRCA carrier to "living in a constant state of fear," adding, "I am sure more male BRCA carriers will follow suit."

    Experts dispute medical need

    Alan Ashworth, CEO of ICR, says that testing for the BRCA gene has "offered families with an inherited risk for prostate or breast cancer the chance for close monitoring, earlier diagnosis, and preventative management," adding, "Our knowledge of cancer genetics is now increasingly shaping the way we treat the disease… for people who have inherited cancer genes."

    However, Marc Ginick—a professor at Beth Israel Deaconess Medical Center—says that performing a prostatectomy solely because a man has a higher risk of developing cancer is a complex issue that deserves more research. "Currently, a man's decision to undergo a prophylactic radical prostatectomy because he is carrying the BRCA gene is based predominantly on emotions, not data" (Chustecka, Medscape Medical News, 5/21; Scutti, Medical Daily, 5/20; UPI, 5/22; Ward, The Telegraph, 5/19). 

    The Journey to Personalized Medicine

    How can you plan for the rise in genetic testing and targeted therapies?

    From risk assessment  to shared decision-making to self-management, the Oncology Roundtable has identified nine steps—laid out in this easy-to-navigate infographic—that your organization can take on the path toward personalized medicine. 

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