The Institute of Cancer Research (ICR), has responded to the draft recommendation from the National Screening Committee (NSC) to implement a targeted prostate cancer screening programme for men with a confirmed BRCA1 and BRCA2 variant.
The draft recommendation, which will now go to a public consultation for three months, has recommended that men with a confirmed BRCA1 and BRCA2 variant should have a PSA test every two years, from age 45 to age 61.
Professor Ros Eeles, Professor of Oncogenetics at the ICR, said the move would represent a vital step towards reducing deaths from prostate cancer: "We're very pleased to see that the National Screening Committee has recommended that PSA testing for men who carry BRCA1 and BRCA2 mutations is introduced. This recommendation is based on research led by my team at The Institute of Cancer Research, which showed that these men face a significantly higher risk of developing prostate cancer and are more likely to experience aggressive forms of the disease. PSA testing picks up cancers at an earlier stage, when they are easier to treat – which will ultimately save lives."
However, Professor Eeles added that cancers could be missed if screening only occurs every two years. Data from the IMPACT screening trial showed that cancers were picked up in each year that BRCA2 carriers were tested, and in all but one of the five consecutive years that BRCA1 carriers were tested.
Professor Eeles added: "We therefore recommend annual screening, rather than every two years – to avoid the risk that an aggressive cancer could be allowed to grow unchecked for a whole year. The NSC has recommended that BRCA carriers be tested from the age of 45 to 61. Our research offered screening for cancers for a wider age range, and I am concerned that if you stop screening at 61 years of age, a large number of cancers will be missed. Of the cancers we found in the IMPACT trial, 49% of them in BRCA1 carriers were between the ages of 61-69, and for BRCA2 carriers 42% were in this age group. We are urging regulatory bodies to act on the evidence, offering all men with a BRCA1 or BRCA2 mutation from the age of 40 – up until the age of 69 – annual PSA testing. This has been the recommendation in Europe, to date, for BRCA2 carriers.
"Today’s recommendation is indeed a vital step toward reducing deaths from prostate cancer. However, unless BRCA testing is expanded, there are thousands of men who will miss out on this screening programme. The NHS needs to offer BRCA testing to more men, starting by offering testing to male relatives of BRCA carriers."
The Institute of Cancer Research (ICR) has played a pivotal role in providing the evidence for the NSC's decision. It was 30 years ago this year that researchers at the ICR discovered the BRCA2 gene, which plays an essential role in protecting against cancer. Inherited faults in this gene, and in BRCA1, can significantly increase the risk of breast, ovarian, prostate and pancreatic cancers.
Black men are also at an increased risk of developing prostate cancer. The NSC has not recommended screening for this group, as they state that there is currently a lack of data. Researchers at the ICR have identified new genetic variants that could explain some of this increased risk and have built a genetic profile of prostate cancer risk that is applicable to men of diverse ancestries. At the moment, the PSA test is not a good enough marker of increased risk of disease in this group of men, as they have a naturally higher PSA level than men of European ancestry.
The ICR is leading the PROFILE trial, which is carrying out targeted screening for Black men, men with a family history of prostate cancer, and those with genetic alterations including BRCA. The study involves MRI scans, a biopsy and biological samples, to look for new markers that we hope will be better at detecting prostate cancer than a PSA test.
In addition, the ICR is a co-lead on the TRANSFORM trial – the biggest prostate cancer screening study in a generation. The trial will test the most promising prostate cancer screening techniques available – including a saliva test to assess genetic risk of the disease – to identify the safest, most accurate and most cost-effective way to screen men. The TRANSFORM trial will ensure that at least 1 in 10 men invited to take part are Black, in order to build an evidence base for the NSC to consider.