Tuesday, 21 May 2013

BRCA2 and the good news that got lost in the headlines


This weekend the papers reported that a man – who carried the faulty BRCA2 gene – had undergone surgery to remove his prostate as a form of preventative treatment for prostate cancer. The articles published in the Sunday Times and Daily Mail – which follows the news that Angelina Jolie had preventative surgery for breast cancer – stated this man was the first in the world to go through such a procedure.

Strictly speaking, and although it ruins a good news story, this is not true. This gentleman had early signs of malignancy in his biopsy results, so wasn’t cancer free. He used the information that he carried the BRCA2 gene as a decision maker to choose which treatment to have. The world is still to see a preventative prostatectomy, and with the evidence as it stands, I hope it stays that way.

There is currently little (if any) information or research on the effect of preventative prostatectomy for prostate cancer and we don’t know enough about the clinical outcomes. Removal of the prostate can lead to serious (and long term) side effects, including erectile dysfunction and incontinence. Put simply, there’s no data whatsoever on whether carrying out this surgery will improve survival rates or men’s quality of life. It’s also worth remembering that many men develop prostate cancer because of other factors other than carrying the BRCA2 gene. In fact, only five to 10 per cent of prostate cancers are thought to be strongly linked to inherited risk.

Last month I wrote about new research from the ICR that linked BRCA2 with aggressive prostate cancer and the need for treatment. It was through taking part in a similar study that the man in question found out he carried this faulty gene. This research is important and could lead to advances that help men with prostate cancer, but not through preventative surgery at this stage.

Through all this discussion around preventative surgery, it’s easy for the good news to get lost: identifying the link between the BRCA2 gene and aggressive prostate cancer is a great step forward for men’s health. In the short term, we can offer men with this faulty gene genetic counselling and frequently screen them for any sign of prostate cancer. In the long term, and with further research, we could be in the position to tell aggressive from non-aggressive prostate cancer in a simple and effective way. Now there’s a newsworthy story.