Multi-parametric magnetic resonance imaging (mpMRI) informed targeted biopsy added to systematic biopsy in biopsy-naïve men increases the number of ISUP grade>2 and grade >3 PC by approximately 20% and 30%, respectively (1). The prostate health index (PHI) is more accurate than total PSA, free-PSA and % free-PSA in predicting PC in men with a family of PC. (2). This study aimed to investigate a new strategy to identify and screen men with a BRCA 2 mutation for early detection of prostate cancer, using PSA, PHI and mpMRI to aid in establishing an accurate diagnosis.
This was a multistep observational cohort study. Data were initially collected from women with a breast, or ovarian cancer observed in the last three years at a single center. Genetic counseling was offered, and BRCA 2 testing was done to all the sons and brothers of these women found to have a BRCA 2 mutation. If one of these men were found to harbor a BRCA 2 mutation, his PSA was measured, and the algorithm depicted in figure 1 was followed, based on his PSA levels.
Figure 1 – PSA algorithm for men with a BRCA 2 mutation:
The results demonstrated that a total of 610 women were tested overall, with 32 (5.2%) being positive for BRCA 2 mutation, and a total of 11 men (31.4%) were found to be BRCA 2 mutation carriers as well.
The mean age of these men was 48. None of these men had a positive digital rectal examination, and their median PSA was 0.54 ng/ml, with a median PHI of 15.93. One man had a PHI above the normal range, and consequently had an mpMRI, which was negative.
Dr. Lazzeri concluded, that this is a proof of principle study, supporting an accurate assessment of male population in order to detect and screen men carriers of BRCA 2 mutation. Dr. Lazzeri suggests further international and multicenter collaboration so that implementing screening programs can be achieved in genetically-defined high-risk men.
Presented by: Massimo Lazzeri, MD, Humanitas Clinical Research Hospital / Humanitas University
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
References:
- Rouvière O, Puech P, Renard-Penna R, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol. 2019 Jan;20(1):100-109. doi: 10.1016/S1470-2045(18)30569-2. Epub 2018 Nov 21.
- Lazzeri M, Haese A, Abrate A, et al. Clinnical performance of serum prostate-specific antigen isoform [-2]proPSA (p2PSA) and its derivatives, %p2PSA and the prostate health index (PHI), in men with a family history of prostate cancer: results from a multicentre European study, the PROMEtheuS project. BJU Int. 2013 Aug;112(3):313-21. doi: 10.1111/bju.12217.