Multiple primary cancers in a single individual can suggest the presence of a germline cancer predisposition gene mutation. Now, in a study published online in Cancer (June 28, 2017), researchers report that men with prostate cancer and one or more additional cancers may have a higher chance of harboring a germline cancer predisposition gene mutation compared to the general population of men with prostate cancer.
The study also found that the majority of the men with a germline cancer predisposition gene mutation did not meet existing criteria for clinical genetic testing.
Senior author Kathleen A. Cooney, MD, of the Huntsman Cancer Institute and University of Utah, Salt Lake City, told Urology Times, “It is important to note that we used very stringent criteria for case selection to increase the likelihood of finding germline mutations, including early age of onset for the first cancer (≤55 years), more than two primary cancers, and the presence of rare cancers. Still, we believe that practicing urologists should be aware that men with prostate cancer and one or more additional primary cancers may harbor a germline mutation in a cancer susceptibility gene, and they should consider referring these patients to a cancer genetics clinic for further evaluation when appropriate.”
The study included 102 men identified from the University of Michigan Prostate Cancer Genetics Project and Cancer Genetics Clinic registry. A certified genetic counselor reviewed each patient’s personal and family histories to determine their eligibility for clinical genetic testing based on criteria from the 2015 guidelines of the National Comprehensive Cancer Network for hereditary breast-ovarian cancer, Li-Fraumeni syndrome, Lynch syndrome, PTEN hamartoma tumor syndrome, or familial adenomatous polyposis. Gene mutational analysis was done using a multigene panel approach.
In this population, melanoma was the most common additional primary cancer and was reported in 33% of the participants. The prostate cancer had a Gleason score ≥7 in 50 men (56.8%) and was clinically aggressive (Gleason score >7, T3b or T4 disease, PSA >15 ng/mL, Gleason score 7 with a PSA >10 ng/mL, or N1 or M1) in 31 men (30.4%).