THE "NEW" PROSTATE CANCER INFOLINK

It is not entirely surprising to come across a paper suggesting that male carriers of the BRCA1/2 genes are at risk for worse post-treatment outcomes than non-carriers of these genes after standard forms of first-line treatment for prostate cancer.

Castro et al. looked at data from a cohort of > 1,300 men who received definitive first-line treatment for local or locally advanced prostate cancer. Their objective was to assess the outcomes of patients carrying the BRCA1/2 genes and to compare them to the outcomes of the non-carriers by looking at such outcomes as metastasis-free survival and prostate cancer-specific survival over time. Specifically, the study explored such outcomes as median survival data and survival rates at 3, 5, and 10 years post-treatment.

Here are the core study data and findings:

• The study cohort included 1,302 men with local or locally advanced prostate cancer.
  • 535/1.302 patients (41.1 percent) were treated by radical prostatectomy.
  • 767/1,302 patients (58.9 percent) were treated by radiation therapy.
  • 67/1,302 patients (5.1 percent) were BRCA1/2 carriers.
    • 35/67 BRCA1/2 carriers were treated by radical prostatectomy.
    • 32/67 BRCA1/2 carriers were treated by radiation therapy.
• Median patient follow-up was 64 months or just over 5 years.
• At 3 years post-treatment,
  • 90 percent of BRCA1/2 carriers were free from metastasis.
  • 97 percent of non-carriers were free from metastasis.
  • The prostate cancer-specific survival rate among BRCA1/2 carriers was 96 percent.
  • The prostate cancer-specific survival rate among non-carriers was 99 percent.
• At 5 years post-treatment,
  • 72 percent of BRCA1/2 carriers were free from metastasis.
  • 76 percent of non-carriers were free from metastasis.
  • The prostate cancer-specific survival rate among BRCA1/2 carriers was 76 percent.
  • The prostate cancer-specific survival rate among non-carriers was 96 percent.
• At 10 years post-treatment,
  • 50 percent of BRCA1/2 carriers were free from metastasis.
  • 84 percent of non-carriers were free from metastasis.
  • The prostate cancer-specific survival rate among BRCA1/2 carriers was 61 percent.
  • The prostate cancer-specific survival rate among non-carriers was 85 percent.
• BRCA mutations were an independent prognostic factor for
  • Metastasis-free survival (hazard ratio [HR] = 2.36)
  • Prostate cancer-specific survival (HR = 2.17)

It is well understood that men who carry the BRCA1 or BRCA2 genes are at high risk for more aggressive forms of prostate cancer (although we are still learning exactly why this seems to be the case). It is inevitable that this increase in risk for aggressive disease was going to turn into a long-term risk for worse clinical outcomes if such patients received only standard forms of first-line treatment and/or if they weren’t diagnosed and treated early enough.

What this study clearly shows us is the importance of identifying male carriers of the BRCA1/2 genes as part of the characterization of men who come from BRCA1/2 carrier families, individualized testing programs for such men to ensure early diagnosis, and appropriately aggressive treatment to minimize the chance of early micrometastasis leading to inevitable, evident metastatic disease among such men.

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment | Tagged: BRCA1/2, mutation, outcome, risk, Treatment |