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Although most prostate cancers can be slow growing, some prostate cancers can be more aggressive. These aggressive cancers can become resistent to standard hormone therapy and metastasize (spread) to areas beyond the prostate. Recent research shows a link between these aggressive prostate cancers and inherited mutations in BRCA1, BRCA2, ATM and CHEK2.
Approximately 10% of men with a hormone-resistant, metastatic prostate cancer will test positive for one of these mutations. As a result, national guidelines are now beginning to recommend genetic counseling and testing for all men with metastatic prostate cancer to determine whether or not they have an inherited genetic mutation that is relevant to their cancer.
Men with a BRCA or other mutation who develop prostate cancer may be offered more extensive treatment sooner than patients who do not have a known mutation. Prostate cancer patients with a known mutation may qualify for participation in clinical trials of targeted therapies. Many ongoing studies are specifically designed for BRCA carriers with prostate cancer, including those that are looking at the use of platinum-containing drugs that are effective against other BRCA-related cancers, and PARP inhibitors, which are approved for use in some ovarian cancer patients with BRCA mutations.
Men from families with a BRCA or other mutations should consider genetic testing to help them and their doctors to decide on the most appropriate surveillance strategies for prostate cancer and to determine best treatment if they develop the disease. Cancer genetics is rapidly changing, so men with prostate cancer should also consider seeking cutting-edge opinion from experts at major cancer centers.