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.