How to prevent BRCA-related prostate cancer? I learned that I carry a mutation of the BRCA gene, the same genetic mutation that led American actress Angelina Jolie to undergo a double mastectomy and removal of her ovaries to prevent the onset of disease. Can I have a radical prostatectomy or a proactive treatment to prevent prostate cancer?

The short answer to this question is no. The risk of developing cancer is different for women and men carrying the BRCA mutation. Women with a mutation in this gene have a higher risk of developing breast and ovarian cancer in their lifetime than the risk of developing prostate, pancreatic, or breast cancer in men.

If you carry this mutation and want to take preventive measures, it is important to discuss your options with your doctor or a genetic counselor.

When should prostate cancer screening begin for those carrying the BRCA mutation?
While screening is recommended for all men over 50 years of age and at 45 years of age in the presence of risk factors, annual prostate cancer screening is recommended for all men over 40 years of age who carry the BRCA mutation. This should include a PSA (prostate-specific antigen) blood test paired with a rectal exam. These tests can detect prostate cancer at an early stage, which can improve the chances of cure.

If diagnosed with prostate cancer…
If you have received a diagnosis of prostate cancer and your doctor believes that active surveillance is a suitable option for a man without the BRCA mutation, it is possible, after discussion, that the recommended preventive measure for you may involve considering a treatment such as radical surgery or radiotherapy instead of opting for active surveillance and waiting for the cancer to progress before treatment.

How do I know if I carry this genetic mutation?
Some indicators may suggest that prostate cancer is due to an inherited mutation, such as a family history of breast, ovarian, pancreatic, or prostate cancer, a young age at diagnosis, and the presence of multiple tumors. In the presence of such indicators, your doctor may recommend tests to check for the presence of a genetic mutation.

In summary, there is currently no specific recommended form of prostate cancer prevention for men with a BRCA mutation. Eating well and adopting a healthy and active lifestyle remain the best form of prevention against prostate cancer. Prophylactic prostate removal (prostatectomy) is not recommended. However, men with a BRCA gene mutation, especially BRCA2, may be advised to pursue a more aggressive treatment approach for lower-grade prostate cancers compared to those without this mutation.

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