I am concerned both on a professional and personal level about the United States Preventive Services Task Force (USPSTF) recent draft guidelines that recommend against PSA screening for men of average risk or who are high risk by virtue of a family history of cancer. FORCE has prepared a position statement in response to this draft and we are encouraging our members to read our statement and submit commentary to the USPSTF.
My father died of prostate cancer. No matter how much I told him about BRCA, the hereditary cancer link, and his own risk for cancer, he ignored his health and refused to get checked. When he developed a severe case of pneumonia that put him in the hospital, he had his first physical exam and blood work in 35 years. His PSA was elevated. Only after he had serious symptoms did he finally agree to a biopsy; by then the prostate cancer was advanced. It took his life the following year. I have two brothers and worry about them. Like most parents with a BRCA mutation, I also worry about whether or not I passed my mutation on to my son.
Although it is true that men with mutations do not have the same extraordinary high risk as women with mutations, men do have a very elevated lifetime risk, as high as 33%. Like other cancers in mutation carriers, BRCA-associated prostate cancers are different than sporadic prostate cancers. In men without mutations, prostate cancers are often slow in onset, asymptomatic, and may never progress or affect quality-of-life or lifespan. Recent research, however, shows that men with BRCA2 mutations who develop prostate cancer are more likely to develop cancer at a younger age, have an aggressive form, and die of the disease compared to those in the general population. So guidelines for prostate cancer screening for the general population may not apply to those with mutations. The ongoing IMPACT study, an international collaboration, is looking at whether PSA can improve detection of prostate cancer and survival in mutation carriers.
In drafting their latest recommendations, the United States Preventive Services Task Force (USPSTF) did not take into account any of the published studies that relate specifically to men with mutations. FORCE plans to submit our position statement to the USPSTF, strongly urging that the guidelines be revised to clarify that they are not meant for men who have a BRCA mutation or a high likelihood of carrying a mutation. Please read our full position statement on the guidelines. The USPSTF is accepting public comments on the proposed guidelines until November 10. We have a chance to influence the final recommendation so that it takes into account high-risk men with mutations. Let’s advocate for the men in our community and help save lives!
If you are a man with a BRCA mutation and you are interested in participating, visit the IMPACT study website.