FORCE advocates for families facing hereditary breast and ovarian cancer in areas such as access to care, research funding, insurance, and privacy.
If you are a man with a BRCA mutation or you have male relatives with a mutation, take our survey and help us advocate for more research.
In May 2012, The United States Preventive Services Task Force (USPSTF) issued their recommended changes for prostate cancer screening in men. The draft guidelines recommended against PSA screening for men of any age. In response to the concerns submitted by FORCE that the guidelines might not apply to people with BRCA mutations, the USPSTF modified the guidelines to reflect this important detail. Read the full USPSTF Guidelines for Screening for Prostate Cancer.
According to the USPSTF, the primary goal of prostate cancer screening is to reduce deaths due to prostate cancer. Research shows that screening using PSA increases detection of prostate cancer. However, PSA screening has risks and limitations including:
Given the above, the USPSTF analyzed research studies that looked at prostate cancer screening and outcomes to determine if the research showed a net benefit from screening. In October, 2011, the USPSTF issued draft guidelines that recommended again PSA screening for all men and invited input and feedback from organization and individuals.
FORCE contacted the USPSTF in response to the draft guideline changes and presented the following information:
Men with BRCA 2 mutations face:
Edwards et. al. published data which showed a poorer prognosis and overall survival for BRCA2 mutation carriers versus non-mutation carriers diagnosed with prostate cancer. Based on this and previous work, BRCA2 mutation status is now recognized as an independent prognostic factor and marker of poorer overall survival. The IMPACT Trial is a large international study examining PSA in men with and without BRCA mutations. The study will be completed in 2020 and will determine if PSA screening improves detection and outcomes in mutation carriers. Early analysis from IMPACT suggests a benefit of PSA screening in men with BRCA mutations.
FORCE requested that the USPSTF take into account the above concerns and we urged the addition of language to clarify that the guidelines are not meant for men with a BRCA mutation, or those with a high-likelihood of carrying a mutation.
The USPSTF issued new prostate cancer screening guidelines on May 21, 2012.
The Task Force took into account our concerns about prostate cancer in men with BRCA mutations and added the following statement to their guidelines:
"This recommendation...does not consider PSA-based testing in men with known BRCA gene mutations who may be at increased risk for prostate cancer."
It is important to note that not all professional societies agree with these new guidelines and some believe that PSA screening should be available to all men after a conversation with their health care providers on the benefits and risks of screening.
Gallagher DJ, Gaudet MM, Pal P, Kirchhoff T, Balistreri L, Vora K, Bhatia J, Stadler Z, Fine SW, Reuter V, Zelefsky M, Morris MJ, Scher HI, Klein RJ, Norton L, Eastham JA, Scardino PT, Robson ME, Offit K. Germline BRCA mutations denote a clinicopathologic subset of prostate cancer. Clin Cancer Research, 2010 Apr 1;16(7):2115-21.
Kote-Jarai Z, et. al. BRCA2 is a moderate penetrance gene contributing to young-onset prostate cancer: implications for genetic testing in prostate cancer patients. Br J Cancer, 2011 Oct 11;105(8):1230-1234.
Mitra, AV, et. al. Targeted prostate cancer screening in men with mutations in BRCA1 and BRCA2 detects aggressive prostate cancer: preliminary analysis of the results of the IMPACT study. Br J. Urology. 2011 Jan; 107(1): 28-39.