A potential future for prostate cancer risk assessment

A recent article in the International Journal of Cancer lays out a possible future scenario for prostate cancer risk assessment that takes specific account of familial and hereditary risks for clinically significant prostate cancer.

In this article, Lynch et al. make a number of key points that are relevant to how prostate cancer risk assessment may need to be conducted in the not too distant future. These include the following:

  • Prostate cancer has the highest level, among all cancers, of genetic transmission of susceptibility.
  • In some families, the hereditary risk is so high that it mimics what is known as an “autosomal dominance trait“. However, …
  • No one particular genetic mutation is a definitive genetic risk factor for clinically significant prostate cancer.
  • Many independent, prostate cancer-associated genetic loci have been identified on separate chromosomes.
  • Multiple genetic markers, derived from differing types of study (e.g., linkage studies and genome-wide association studies), are known to be involved with potential risk for prostate cancer.
  • At least one subset of the various genetic alleles is associated with risk for early onset and aggressive cancer.
  • Likelihood that any one mutation will predicting future development of prostate cancer is low.
  • The two strongest predictors for risk of prostate cancer are the BRCA2 mutations, and the G84E mutation in HOXB13.
  • The presence of multiple risk alleles is more highly predictive of prostate cancer than any one  single allele.
  • The practicality of screening large panels for multiple genetic alleles is rapidly increasing.
  • We reviewed the known predisposing genetic markers to assess possible strategies for screening of families at risk.

Lynch et al. argue that — at least for selected patients with some types of family history or other genetic indicators of elevated risk for clinically significant prostate cancer, it is time to initiate the use of testing for selected genetic alleles along with PSA tests (or PSA-like tests) as ways to increase the likelihood that we can identify prostate cancer early and treat it as early as seems appropriate in relevant patients.

It may be a while before this type of testing can become routine across the populations at known risk for prostate cancer, but it is highly relevant that some of the leading figures in the prostate cancer research and treatment community are ready to start thinking seriously about this possibility.

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