Prostate cancers spread more quickly and are more often fatal in men who have inherited a faulty gene, a new study has warned.
The team at The Institute of Cancer Research, London, and The Royal Marsden National Health Service (NHS) Foundation Trust found men who develop prostate cancer after inheriting a faulty BRCA2 gene need immediate surgery or radiotherapy rather than being placed under surveillance, as their disease is more aggressive than other types.
The research could challenge current NHS guidelines for prostate cancer, under which BRCA2 mutation carriers are offered the same treatment options as non-carriers.
The new study, published in the Journal of the Clinical Oncology, is the largest to compare prostate cancer patients with and without BRCA mutations.
"It is clear from our study that prostate cancers linked to inheritance of the BRCA2 cancer gene are more deadly than other types," said senior author Professor Ros Eeles, Professor of Oncogenetics at The Institute of Cancer Research (ICR) and Honorary Consultant in Clinical Oncology at The Royal Marsden.
"It must make sense to start offering affected men immediate surgery or radiotherapy, even for early-stage cases that would otherwise be classified as low-risk.
"We won't be able to tell for certain that earlier treatment can benefit men with inherited cancer genes until we've tested it in a clinical trial, but the hope is that our study will ultimately save lives by directing treatment at those who most need it," Eeles said in a statement.
The team examined the medical records of 61 BRCA2-mutation carriers, 18 BRCA1-mutation carriers and 1,940 non-carriers.
They found BRCA1/2 mutation carriers were more likely to be diagnosed with advanced stage prostate cancers (37 per cent versus 28 per cent) or cancer that had already spread (18 per cent versus nine per cent) than non-carriers.
Among those whose cancers had not spread out of the prostate at diagnosis, within five years, more carriers than non-carriers had metastatic disease (23 per cent versus seven per cent).
Patients with BRCA2-mutations were also significantly less likely to survive the cancer, living an average of 6.5 years compared with 12.9 years for non-carriers.
Men with a BRCA1-mutation also had a shorter average survival time of 10.5 years, but there was not a statistically significant difference with non-carriers.
