Risky business

Women aren’t the only ones jumping on the BRCA testing bandwagon.

Shortly after Angelina Jolie made her big announcement this spring, a 53-year-old British man made headlines for being the first male BRCA2 carrier to undergo preventive prostate removal.

BRCA mutations are as rare in men as they are in women, with just over 1 percent carrying the BRCA2 gene and less than 0.5 percent carrying BRCA1. Previous research has shown that BRCA2 mutations raise prostate cancer risk by roughly nine-fold, while BRCA1 raises the risk around three-fold.

This man was part of a recent trial that investigated how BRCA genes affect prostate cancer prognosis. Findings revealed that 37 percent of the men with these faulty genes had advanced prostate cancer–versus 28 percent of non-carriers.

Cancer had spread among 18 percent of the BRCA-positive men, as opposed to 9 percent of the non-carriers. And among the subjects without metastasis, cancer began to spread in 23 percent of BRCA carriers within five years–versus just 7 percent of non-carriers.

Among this study’s other noteworthy findings: BRCA2 carriers lived half as long post-diagnosis. But there wasn’t a significant difference in survival times for BRCA1 carriers.

Does this subject warrant more research? Absolutely. But you can probably guess my thoughts on it, nevertheless.

According to reports, doctors were reluctant to perform surgery on this patient until a biopsy showed microscopic malignant changes. But here’s the thing: You’ll generally find prostate cancer cells in 50 percent of men at age 50, in 60 percent at age 60, and so on.

There’s a reason why even mainstream medicine is pushing for a greater emphasis on “watchful waiting.” At the end of the day, all men will end up with prostate cancer.

And you’re far more likely to live with it than you are to die from it–bottom line.

The latest research suggests that BRCA carriers may have more aggressive cancers. But these are preliminary findings at best. And they’re by no means the final word on the subject.

Aside from the risks inherent to all surgery, prostate removal often comes with serious life-altering consequences–including irreversible incontinence and impotence.

Radical prostatectomy is not a decision to make lightly. This man made the choice that he was the most comfortable with. And on those grounds alone, it has my full support.

That said, I hope this particular preventive strategy remains an unpopular one.

Germline BRCA mutations are associated with higher risk of nodal involvement, distant metastasis, and poor survival outcomes in prostate cancer. J Clin Oncol. 2013 May 10;31(14):1748-57.