Most people have probably heard of BRCA gene mutations, particularly when it comes to women and breast cancer/ovarian cancer. (In 2013, the actress Angelina Jolie increased BRCA awareness when she publicly shared her decision to undergo a double mastectomy due to her BRCA gene mutation and family history with breast cancer.)
What many people don’t know is the connection between BRCA gene mutations and prostate cancer. At Greater Boston Urology, we're aiming to fix this disparity (along with other organizations, such as ZERO – The End of Prostate Cancer and BRCAblue.org).
Our CEO, Dr. Michael J. Curran, recently appeared on a Facebook Live event with the folks at ZERO to discuss BRCA gene mutations. We asked Dr. Curran to recap the salient points in the Q&A below.
Reminder: the information here and elsewhere on our site is merely educational in nature and should not to be considered medical advice or a diagnosis. Always consult your physician about your specific medical needs.
What is a BRCA gene?
CURRAN: Some genes in the human body make proteins or elicit certain behaviors. Other genes serve as repair genes—they help repair damaged DNA. The BRCA gene is one of the repair genes, and everyone has them.
What is a BRCA gene mutation?
CURRAN: Sometimes BRCA genes mutate, meaning they become permanently damaged. They can no long serve their important function of repairing damaged DNA.
How/when do BRCA gene mutations occur?
CURRAN: BRCA gene mutations can occur in two different ways:
- Germline mutations (a.k.a. "germinal" mutations) are inherited from either your mother or your father. If it's a germline mutation, then all of the cells in your body will have this BRCA gene mutation from the moment you're born.
- Somatic mutations can be acquired at any point over a person's lifetime. Somatic mutations might occur because something happens environmentally (such as exposure to harmful chemicals) or due to the ageing process. As BRCAblue.org notes, acquired BRCA mutations are only present in tumor cells, such as prostate cancer.
Why are BRCA gene mutations important when it comes to men and prostate cancer?
CURRAN: There are two reasons. The first reason is the screening process. If a man has the BRCA gene mutation, he is at a higher risk for developing prostate cancer. As a result, he should be screened more aggressively because early detection of prostate cancer saves lives.
The second reason is this: if a man has the BRCA gene mutation and he develops prostate cancer, he is much more likely to have an aggressive form of prostate cancer.
What if a man reading this article has already been diagnosed with prostate cancer, but he doesn't know his BRCA gene status? Is it still important for him to undergo genetic testing?
CURRAN: At GBU, we think it's important for two reasons. The first reason has to do with the previous point: if they have the BRCA gene mutation, they could have a more aggressive form of prostate cancer than a biopsy indicates.
The second reason involves treatment. We'll likely treat a man with prostate cancer and who has the BRCA gene mutation differently from someone without the BRCA gene mutation. For example, we probably wouldn't keep somebody with a BRCA gene mutation on active surveillance. And if they have advanced prostate cancer, there are different types of medical drug therapies that we can give the patients with BRCA gene mutations as opposed to the other prostate cancer patients.
What if a man doesn't know his BRCA gene status, but he also doesn't have a family history of prostate, breast, or ovarian cancer? Is it still a good idea for him to undergo genetic testing?
CURRAN: It's never a bad idea to know your genetic compositions, provided you do so under the watchful gaze of a medical professional with expertise in genetic testing.
Genetic testing is an exciting, yet incredibly complex field. So we would tell those men who want to know their BRCA status that we'd be happy to help facilitate this testing so they can understand this important genetic link.
Keep in mind that with somatic mutations, a man's BRCA status can change over time, since somatic mutations can happen at any point in the person's life. It's a dynamic process inside the tumor and inside the patient, and those things can change and evolve.
So, for example, let's say the patient was tested for the BRCA gene mutation, but it came back negative. Yet, over time, we're seeing his clinical course deviate—maybe his PSA is rising more rapidly or he's gone from having localized prostate cancer to metastatic prostate cancer. He could have had a change in his BRCA gene. At that point, it might be a good idea to retest him and see what his BRCA gene status is.
We always tell people this type of genetic screening process should be done in close connection with their primary care doctor and/or urologist. Have these conversations with your doctors to find out which tests are appropriate and why they would be appropriate.
How is BRCA testing done?
CURRAN: Testing a man's BRCA gene status involves a blood test. The blood sample is sent to a lab specializing in genetic testing. The lab uses DNA analysis to identify any mutations.
How does insurance coverage play into this? Have you found any issues around insurance coverage when it comes to testing men's BRCA gene status?
CURRAN: Right now, our biggest challenge is with the insurance industry, because many insurance companies are not covering BRCA gene testing for men. Insurance companies will usually cover the testing for women if they have a family history of breast/ovarian cancer. For men, it will get covered if you have a family history, but we actually have to show a higher level of concern with that family history, more different types of cancer in the family, more specific types of cancer, and so forth.
It would be great to see the insurance industry realize that understanding men's BRCA status early on can actually save the insurance company money in the long run because we can better treat those patients. So in our mind, testing a man's BRCA status is a win-win for everyone: the patient, the doctor, and the insurance companies.
Thank you, Dr. Curran!
Here are more articles related to prostate cancer:
- Our Roundup of Prostate Cancer Resources
- GBU's Approach to Prostate Cancer
- GBU's Approach to Advanced Prostate Cancer