An update on hereditary and familial prostate cancers

For those interested in “brushing up” on their understanding of the risks associated with hereditary and familial forms of prostate cancer, we recommend a brief article in the April issue of the AUA News, which summarizes a “state of the art” lecture to be given by the author at the upcoming annual meeting of the American Urological Association.

In this brief article, Cooney begins by differentiating between what are believed to be the truly hereditary forms of prostate cancer and those where there is a simply some evidence of a genetic component in some families:

  • In truly hereditary forms of prostate cancer, which may account for up to 5 percent of all cases of prostate cancer, there is a clear and strong set of genetic signals over several generations.
  • In familial forms of prostate cancer, which seem to account for another 15 to 20 percent of all prostate cancers, the evidence of a genetic component is less clear and may not be as strong from generation to generation.

The bottom line to Cooney’s article is simple. We are still early in the development of understanding how genetics and heredity affect risk for clinically significant prostate cancer, but there are a few places where we can give some strong guidance:

  • Having a brother with prostate cancer is one of the strongest genetic signals of risk — far stronger than having a father or a grandfather who was diagnosed with prostate cancer.
  • Men who have the BRCA1 or the BRCA2 deletion mutations are at significantly increased risk for prostate cancer, and so men in families that carry those genes should clearly be tested for the presence of those mutations.
  • Within clearly hereditary prostate cancer families, “risk for unaffected men increases with decreasing age of diagnosis of affected relatives.” In other words, the younger your father or uncle or brother is diagnosed, the higher is your own risk in such families.
  • Men with a clear family history of prostate cancer are wise to initiate PSA testing and physical exams at age 40 — or at 10 years younger than the age of the youngest patient diagnosed in that family.

One Response

  1. As a follow-up to the above report, it is worth taking note of the recent publication by Herkommer et al. describing the experience of the German “familial prostate cancer” project, which has amassed data from 25,065 families since 1999.

    Only 2.6% of patients in this study are categorized as having truly hereditary forms of prostate cancer. In addition, the authors report that the high average age of the patients, the lower life expectancy in further generations, and the low number of first-degree male relatives are all problematic when it comes to the classification of sporadic, familial, and hereditary cases.

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