Male 'Jolie gene' can triple aggressive prostate cancer risk

Men with a mutation to the “Jolie gene” are up to three times as likely to get aggressive prostate cancer, a study has found.

Experts said the findings showed that men at high-risk of the disease should get annual prostate cancer checks from the age of 40, as part of a targeted NHS screening programme.

The research, led by the Institute of Cancer Research in London, examined whether screening using prostate-specific antigen (PSA) tests could pick up aggressive prostate cancer in men with mutated versions of the BRCA 1 or BRCA 2 genes.

The normal versions of the genes protect against cancer by correcting DNA damage, but about one in 400 people carry mutated versions that increase the risk of various cancers, including breast and ovarian.

The BRCA genes are often known as the “Angelina Jolie” gene because the actress discovered that she carried the mutation, which led her to have a preventative double mastectomy in 2013.

The study involved 3,064 men aged 40 to 69, more than half of whom had faulty BRCA genes. Over five years, they had annual PSA blood tests to check for prostate cancer.

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Men with BRCA mutations were twice as likely to have “clinically significant disease”, according to the research, which was presented at the European Society for Medical Oncology congress.

For BRCA 2 carriers, the risk of prostate cancer more than doubled. Those with BRCA 1 mutations were three times as likely to receive a diagnosis of aggressive prostate cancer.

Men with BRCA 2 mutations also developed the disease younger; the average age of diagnosis was 60, compared with 65 for those without the mutation.

Prostate cancer is the most common cancer in Britain, with 55,300 new cases and 12,200 deaths each year.

Professor Rosalind Eeles, who led the study at the Institute of Cancer Research, said: “Our research shows that men with BRCA 1 and BRCA 2 mutations face a significantly higher risk of aggressive prostate cancer. Until more accurate diagnostic tests become available, targeted PSA screening in this high-risk group could detect these cancers earlier, when treatment is more effective.

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“We are urging regulatory bodies to act on the evidence and update current guidance so that all men from 40 years with a BRCA 1 or BRCA 2 mutation are offered annual PSA testing. We are expecting an update to this guidance soon, and we hope to see the inclusion of BRCA carriers in any targeted screening programme, to give these men more control over their health and improve timely diagnosis.”

The National Screening Committee, the expert body that advises the NHS, is due to make recommendations next month as to whether to introduce a new screening programme. The committee is expected to say that the risks of mass PSA testing outweigh the benefits.

However it could recommend a targeted programme, which could involve GPs offering the test to those with a family history of the disease and and black men, who are more susceptible to it.

Professor Clare Isacke, dean of academic and research affairs at the Institute of Cancer Research in London and a co-author of the study, said: “Prostate cancer is now the most common cancer in men, and with rates continuing to rise, it’s essential that we pick up clinically significant cases of prostate cancer at an earlier stage, before it has spread.”

PSA tests measure levels of a protein that can be raised in prostate cancer patients. However, the tests are unreliable and often miss aggressive cancers or provide false positives, causing overdiagnosis. This can lead to men having unnecessary treatment or procedures with side-effects such as incontinence and erectile dysfunction.

Tony McHale, 74, took part in the trial after discovering that he had a mutation to the BRCA 2 gene when he was 61. The annual PSA test and follow-up checks revealed, 18 months later, that he had prostate cancer.

Tony McHale at his home in Buckinghamshire

JOHN ANGERSON

He said: “I couldn’t believe it. I felt completely fine and I had no symptoms. I was immediately given a three-month course of intensive radiotherapy treatment. When it ended, I was told I was clear of cancer. It was a fantastic moment. I cried with relief. It felt like I’d been given a new lease of life.

“Being involved in the Impact study saved my life.”