Beyond breast cancer: What men need to know about how BRCA genes impact prostate cancer risk

When pop culture icon Angelina Jolie announced in 2013 that she had her breasts removed to reduce the long-term risk of developing breast cancer, she quickly and forever changed public perception of BRCA1 and BRCA2 genes and their link to breast cancer.

While her story greatly increased public awareness of the value of knowing your family history, experts say it’s time to rethink what we know about the BRCA1/2 genes and cancer risk.

Breast cancer genes’ role in genetic risk for cancer

Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are two hereditary genes that play a significant role in certain cancers. Despite their names, both genes are associated with more than just breast cancer; they are also linked to an increased risk for pancreatic, ovarian and prostate cancers as well as melanoma, the most serious skin cancer. A change that occurs in either BRCA gene can hinder the gene’s ability to prevent cancer. And that harmful mutation can be passed down from a parent to a child.

“That’s why inherited cancers run in families. If you’re born with a mutated version of either the BRCA1 or the BRCA2 gene, you could be moderately to highly susceptible to getting breast, prostate, pancreatic or ovarian cancers as well as melanoma. Looking at prostate cancer alone, we know that roughly 12% of men with metastatic prostate cancer carry a hereditary gene mutation, most commonly in BRCA2,” says Lindsey Byrne, MS, LGC, a genetic counselor with The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

“The perception is that this is a genetic mutation that impacts biologically female patients and applies to ‘female’ cancers alone. But men are just as likely as women to carry a BRCA1 or 2 mutation.”

Byrne has been working extensively in the Columbus medical community since 2008 to improve access to genetic counseling for an expanded population of impacted patients. She leads a genetics clinic designed to serve patients with prostate, kidney and bladder cancers.

The breast cancer genes’ impact on prostate cancer risk

Until recently, genetic testing for prostate cancer was not recognized by national guidelines for insurance to cover. The Ohio State clinic is one of only a few such dedicated clinics in the United States. Since her clinic launched in the fall of 2018, Byrne has seen hundreds of men with prostate cancer for genetic testing.

“Since prostate and breast cancers are both common in the population, the risk for hereditary prostate cancer is just as concerning as it is for breast cancer. It is important knowledge for people to have, as it can guide treatment options and help family members understand their risk,” Byrne says.

Recent guidance and medical policy changes instituted by the National Comprehensive Cancer Network and other medical governance organizations have improved both access and financial coverage of genetic counseling related to prostate cancer.

“It’s not just about inherited risk from female to female or male to male. BRCA status can impact risk of sons from mothers, daughters from fathers and vice versa,” Byrne adds. “If a mother is BRCA-positive, her daughters should know this to understand their risk for ovarian, breast and pancreatic cancer, melanoma, and sons should know this for pancreatic, prostate cancer, male breast cancer and melanoma.”

Read more about why men should be tested for BRCA breast cancer genes, too

Genetic testing empowers patient to manage prostate cancer risk

This genetic information is an important decision-making tool for risk stratification, which patient Steve Kalister can attest to personally.

Now 50, Kalister was in his 20s when his dad was diagnosed and treated for prostate cancer. He had his prostate removed but declined additional therapy recommended by his doctors at the time due to concerns about the side effects and because it was thought that the entire tumor had been removed.

“His aggressive cancer returned and could not be stopped, ultimately spreading to his bones and brain,” Kalister recalls. “He died at age 61, soon after retirement. I was close with my Dad, and it was devastating. Fast forward to my early 40s and as a new father of twin boys, I wanted to know what I could do to prevent myself from having the same outcome as my father."

Even with his dad’s aggressive prostate cancer experience, Kalister was told by urologists that he should simply start screening tests earlier than men without a family history. In his professional life, however, he works at The James Cancer Hospital and Solove Research Institute, so he decided to contact a prostate cancer expert to find out if there was anything else he should do besides PSA blood tests and prostate exams.

“The physician asked if I had done genetic testing — something that I had never even considered,” Kalister says.

Genetic testing with Byrne revealed, quite to his surprise, that Kalister carried the BRCA2 mutation.

Byrne referred him to a surveillance study at the National Institutes of Health (NIH) for men who are BRCA-positive to monitor for early signs of prostate cancer. He travels to the NIH every two years for magnetic resonance imaging of his prostate as part of the study. He also had a pancreatic MRI due to his family history.

“You can’t control everything, but this knowledge is truly empowering,” he says. “I encourage anyone with a family history of cancer to seek information to help you be more intentional about managing your personal risk. Genetic testing is a simple blood test, and it’s absolutely worth it for peace of mind.”