Imaging-based prostate cancer screening among BRCA mutation carriers-results from the first round of screening
| Autor: | Ofer Benjaminov, Eli Rosenbaum, Yaara Ber, Jack Baniel, David Margel, Liat Shavit-Grievink, N. Segal, Shlomit Tamir, D. Keder, Rachel Ozalvo, Maxim Yakimov, Sivan Sela, Inbal Kedar |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Oncology Adult Male medicine.medical_specialty Prostate biopsy Population Genes BRCA2 Gene mutation urologic and male genital diseases 03 medical and health sciences Prostate cancer 0302 clinical medicine Prostate Internal medicine medicine Humans education Early Detection of Cancer Aged education.field_of_study medicine.diagnostic_test business.industry Incidence (epidemiology) BRCA mutation Prostatic Neoplasms Hematology Middle Aged Prostate-Specific Antigen medicine.disease Magnetic Resonance Imaging 030104 developmental biology medicine.anatomical_structure Prostate cancer screening 030220 oncology & carcinogenesis business |
| Zdroj: | Annals of oncology : official journal of the European Society for Medical Oncology. 31(11) |
| ISSN: | 1569-8041 |
| Popis: | Background Male-carriers of BRCA1/2 gene mutations have an increased risk of prostate cancer (PCa) with a more aggressive phenotype. Current screening-guidelines suggest the use of prostate-specific antigen (PSA) only among BRCA2 carriers. Female carriers have extensive guidelines that include imaging. Our objective was to test the prevalence of PCa among BRCA carriers and examine screening strategies, using PSA and multiparametric magnetic resonance imaging (mpMRI). Patients and methods We recruited men aged 40–70 years with BRCA1/2 germline mutations and no prior history of prostate biopsy. All men underwent an initial round of screening which included PSA, and prostate mpMRI. PSA was considered elevated using an age-stratified threshold of ≥1 ng/ml for 40–50 years of age, ≥2 ng/ml for 50–60 years of age, and 2.5 ng/ml for 60–70 years of age. Men with elevated PSA and/or suspicious lesion on mpMRI were offered a prostate biopsy. PSA levels, MRI findings, PCa incidence, and tumor characteristics were evaluated. Decision curve analysis was used to compare screening strategies. Results We recruited 188 men (108 BRCA1, 80 BRCA2), mean age 54 years (9.8). One hundred and ten (57%) had either elevated age-stratified PSA (75; 40%), a suspicious MRI lesion (67; 36%), or both (32; 17%). Of these, 92 (85%) agreed to perform a prostate biopsy. Sixteen (8.5%) were diagnosed with PCa; 44% of the tumors were classified as intermediate- or high-risk disease. mpMRI-based screening missed only one of the cancers (6%), while age-stratified PSA would have missed five (31%). Decision curve analysis showed that mpMRI screening, regardless of PSA, had the highest net benefit for PCa diagnosis, especially among men younger than 55 years of age. We found no difference in the risk of PCa between BRCA1 and BRCA2 (8.3% versus 8.7%, P = 0.91). Ninety percent had a Jewish founder mutation, thus the results cannot be generalized to all ethnic groups. Conclusions PCa is prevalent among BRCA carriers. Age may affect screening strategy for PCa in this population. Young carriers could benefit from initial MRI screening. BRCA carriers aged older than 55 years should use PSA and be referred to mpMRI if elevated. Trial registration ClinicalTrial.gov ID: NCT02053805 . |
| Databáze: | OpenAIRE |
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