Man Has Prostate Gland Removed Because He Tested Positive For The BRCA-Gene

BRCA-2 Gene

Angelina Jolie has come forward and shared with the world her story about having prophylactic bilateral mastectomies and breast reconstruction after learning that she tested positive for the BRCA2 gene mutation that is highly predictive of developing breast cancer.

BRCA gene mutations increase the risk for a number of cancers, including prostate cancer. Now the first man has come forward who tested positive for the BRCA gene mutation who had his prostate gland removed. The surgery took place in London by an eminent surgeon who also had his prostate gland removed for prostate cancer after prostate cancer was found.

Previous results from this trial have shown that a man with a BRCA2 mutation has an 8.6-fold increased risk of developing prostate cancer, and with a BRCA1 mutation has a 3.4-fold increased risk. The same researchers reported that prostate cancer in men with the BRCA2 mutation is more aggressive and more likely to be fatal (J Clin Oncol. 2013;31:1748-1757).

The man who underwent the surgery is described as a 53-years-old businessman from London who is married with children and has several family members who have had breast or prostate cancer. When he found out he was carrying the BRCA2 mutation, he asked to have his prostate removed.

What’s my opinion on this first test case of prophylactic prostate gland removal for men with BRCA gene mutation? First, I don’t think American insurance companies, including Medicare, will pay for prophylactic prostatectomies without a diagnosis of prostate cancer confirmed by a prostate biopsy. Second, I wouldn’t recommend a prostatectomy just on the basis of a positive gene test. I think it is far too early to be removing men’s prostate glands with the associated risk of erectile dysfunction and urinary incontinence just on the basis of a blood test. However, if a man with an elevated PSA blood test has one or two relatives such as a father or brother with prostate cancer and a mother with breast cancer and it is highly likely that he may have or will develop prostate cancer, then I would certainly recommend that the man have a prostate biopsy and close monitoring for prostate cancer.

I do suggest that all men with a family history of prostate cancer have an annual digital rectal exam and a PSA blood test.

BRCA Gene Mutation and What It Means For Men

Everyone knows that Angelina Jolie had a double mastectomy as a prophylaxis against developing breast cancer. I think every woman can appreciate how brave she was to undergo the surgery but also how she put this issue on the map and increased the awareness of the BRCA gene. Since Angelina had the mastectomy she has reduced her risk of breast cancer from a dismal 87% to a manageable 5%. But what does the BRCA gene mean if a man carries the gene?

Men and women can inherit and pass on a BRCA mutation. Men with a BRCA mutation have a lower chance overall of developing cancer than do women with a mutation, but their chances of breast cancer, prostate cancer, and a few other specific cancers are increased.
Men with a BRCA gene mutation have a higher risk of developing breast cancer, prostate cancer and skin cancer (melanoma). In some men (and women), BRCA2 gene mutations have been associated with an increased risk of lymphoma, melanoma, and cancers of the pancreas, gallbladder, bile duct, and stomach. Furthermore, these cancers are more likely to develop at a younger age in men with a BRCA mutation. Men with a BRCA mutation have a lower chance overall of developing cancer than do women with a mutation

Both men and women carry the BRCA gene mutation and it is possible for men to inherit the mutated gene from a man’s father.

Men from families with a history of breast and ovarian cancer in the women in the family should consider testing for a BRCA gene mutation particularly if any of the breast cancers occurred before age 50 (in either female or male relatives). Men with breast cancer themselves are highly likely to have a BRCA mutation and should consider testing. Men who have prostate cancer and a family history of breast cancer should also think about testing for the mutated gene.

Men who know they carry a BRCA gene mutation can take proactive steps such as getting screened regularly for some of the cancers associated with the mutation, such as annual prostate cancer screening with a PSA test and annual skin examinations for melanoma. Men with a BRCA mutation should also seek medical advice about any changes in their breasts such as breast tenderness, discharge from the nipple or a breast mass or lump. Even more so, it is important to share this result with your family when you deem appropriate, as it may be life saving information to your sisters, mother and daughters.

Bottom Line: BRCA gene is certainly an important issue for women but it is also important for men as well. If you have a family member with breast or ovarian cancer especially if they have the cancer detected before age 50, then they should have a test for the BRCA gene.

Dr. Neil Baum is physician and the author of What’s Going On Down There, The Complete Guide To Women’s Pelvic Heath and is available from Amazon.com

What’s Going On Down There-Improve Your Pelvic Health (amazon.com)