BRCA gene carrier has prostate removed

A British man has had his prostate removed after testing positive for a mutation in the BRCA2 gene known to greatly increase the risk of cancer. The operation is thought to be the first prostatectomy performed due to an assessment of genetic risk.

The news comes a week after Angelina Jolie's much-publicised article in the New York Times in which the actress discusses her decision to have both breasts removed after learning that she was carrying a faulty version of the related BRCA1 gene.

Following their operations, both Jolie and the anonymous British man now have a considerably reduced risk of developing cancer.

Preventative mastectomies are becoming increasingly common for genetically at-risk women. But the possible side effects of prostate removal, coupled with the effect of less genetic research into prostate cancer, has meant that prostatectomy was not previously considered as a treatment option for men.

Professor Roger Kirby, the surgeon who performed the procedure, told The Sunday Times that for many, 'knowing you are a carrier [of a BRCA mutation] is like having the Sword of Damocles hanging over you. You are living in a state of constant fear'.

He added: 'I am sure more male BRCA carriers will now follow suit'.

His patient originally learned that he was carrying the BRCA2 mutation after taking part in a trial at the Institute of Cancer Research (ICR). Just having the faulty gene would normally be considered insufficient to warrant prostate removal as the operation causes infertility and can result in permanent incontinence and sexual dysfunction.

However, a biopsy revealed subtle changes to some prostate cells associated with the earliest stages of cancer, and doctors agreed to operate. Earlier tests — an MRI, magnetic resonance imaging, scan and a prostate-specific antigen test — had been clear.

'The relatively low level of cancerous cells we found in this man's prostate before the operation would these days not normally prompt immediate surgery to remove the gland', Professor Kirby told The Sunday Times, 'but given what we now know about the nature of BRCA2, it was definitely the right thing to do for this patient'.

The ICR trial that the man had enrolled in was published last month (reported in BioNews 700) and confirmed the greater risk of prostate cancer associated with BRCA1 and BRCA2 mutations. It also suggested that men carrying the BRCA2 mutation were more likely to develop particularly virulent prostate cancers. In the research, BRCA2 carriers lived half as long after cancer diagnosis than non-carriers.

At the time, senior author Ros Eeles, professor of oncogenetics at the ICR, said that NHS guidance should change to take into account the study's findings: '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'.

Prostate cancer affects one in eight men in the UK during their lifetime and causes just under 10,500 deaths annually.