So, can you explain first of all what BRCA testing
is and then if you have prostate cancer why it's important for you to get BRCA testing?
BRCA is a mutation that has come to the forefront in the last few years for a number of reasons.
One is we know it predisposes to prostate cancer. We also know that this mutation signals a higher
and more aggressive type of prostate cancer and the reason it's significant in addition to those
reasons is that it is associated with a higher risk of breast cancer in women, ovarian cancer
and pancreas cancers and melanomas in men and women. So, it's not super common in men that have
prostate cancer if you take all comers it's about 1 in 20 men has this mutation. And, to answer your
question, it's a blood test; you can test for it and see if someone has that particular mutation.
It is about twice as common in people that develop advanced or aggressive cancers; about 10 percent
of men will harbor this particular mutation and it's significant because there is a treatment
for it. So, untreated men with BRCA will have shorter survival, but if treatment is administered
properly with something like Olaparib or Rucaparib it will improve their survival. So, this is a pill
that's used for advanced prostate cancer in men that have become resistant to other treatments.
So, the BRCA mutation has a lot of different implications in the screening population
in men that have been diagnosed with it, they probably want to have their family members,
their children tested to see if they have inherited that mutation
and that way if they're carrying that mutation they'll want to be screened more carefully for
melanomas, breast cancers, prostate cancers, and pancreas cancers.
So, you mentioned Rucaparib and Olaparib. Are those
only available to people who are positive with BRCA?
Yeah, pretty much. There are some other mutations that might allow for coverage
for insurance in men with advanced disease, but it's a lot like alphabet soup and to go through
them in a simple video like this is ridiculous, but it's probably easier to think of it as the
BRCA mutation and then there are some other associated mutations also that might qualify.
So, for a man who has tested positive with braca and he goes to his family member and
they're going to get tested, is there a certain age limit,
you know, for these people to get tested? Do you have to be over the age of 18?
No. So this is something that we transmit. If we have this mutation we can potentially transmit
to our children and the, you know, the risk may be 50/50 or something like that if you're your
father has a BRCA mutation that you have inherited it. So, it's a blood test or they can do a swab of
your mouth or a saliva test and for men that have been diagnosed with prostate cancer the testing
company that we use in our office is called "Invatae" i-n-v-a-t-a-e, and it's covered by
their insurance. For people that, you know, don't have an illness or their father was sick
there are other companies; I think Dr. Klotz in a recent video talked about a
company called Color that can test people for these mutations.
Yeah and they're actually very cheap. I think you can get the
whole test for about $200 to $250 depending on which one you get.
That's very impressive. So, my next question is let's say a man, you know,
his son tests for BRCA and he's positive, at what age should that son go and get PSA testing?
Probably age 40. The typical recommendations for those that agree to screening (even that
can be controversial) is, like, to start at age 45 or 50, and so for men that are
increased risk—we talked about some of those risk factors like if you're African-American—probably
more prudent to start around age 40 to get PSA testing and, of course,
there's a whole a whole lore about PSA testing and a lot of controversy and then what do you do if
your PSA is elevated which we can't go into right now but people should never just go marching into
PSA testing without getting educated in advance as to what's going on in the screening process
because it is possible to get steered down a situation where you could end up with a
prostate removal surgically before you really even know what you're doing, but for those that do
their homework, I do advocate PSA testing starting around 45-50 in people without
risk factors at probably around age 40 in people that have increased risk factors.
And so that's across the board; that's not with people who are, you know, BRCA positive. Like,
it's really those earlier risk factors and age and family history and the weight and
everything that you talked about. I just think that's a really important point
because I don't think people think about PSA testing with risk factors involved.
Yeah, I mean I don't know that I would even wait if I had no risk factors. I mean what's the
harm of getting a PSA test when you're 40? Studies show that if it's like one or less
you can then wait to age 45 before you repeat it again. So, a $30 test, easy to do, why not?
In summary, if you do have a history of prostate cancer in your family or you're
concerned and you're a prostate cancer patient and you're going to get BRCA testing I just
want you to know there are genetic counselors with each of these companies that can discuss
the results with you and go over all the details with you and help you understand it.
If you would like more information about anything that we talked about today you can visit pcri.org.
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