Prostate cancer is the leading cause of cancer and the second leading cause of cancer deaths in American men. Tumors often grow slowly and develop in individuals older than 65.
But certain inherited gene changes, or mutations, raise your chances of getting prostate cancer. Gene mutations can also raise your risk for getting a more aggressive form of prostate cancer. Some people with these faulty genes may also be more likely to develop prostate cancer at a younger age.
Tell your doctor if you have a family history of prostate cancer. They’ll let you know if genetic testing is right for you. If you test positive for BRCA gene changes, your doctor may suggest routine tests that can spot early signs of a tumor.
What Are BRCA Genes?
Every cell in your body has more than 25,000 genes. Each gene provides instructions for how to make certain proteins. These molecules help your cells work the right way.
Everyone has two copies of the BRCA1 and BRCA2 genes, or BReast CAncer gene 1 and BReast CAncer gene 2. You inherit a copy from each of your parents. But sometimes one of the gene pairs is damaged. You may hear these DNA errors called mutations or variants.
BRCA genes are known as “tumor-suppressor” genes. They tell your body how to make proteins that repair cell damage. These genes play a big role in preventing cellular mistakes and killing cells that may promote cancer growth.
Gene defects make it harder to curb genes with cell changes that lead to cancer, or “oncogenes.” And BRCA gene mutations have a link to breast, ovarian, and prostate cancers. Research is looking into why these variants are associated with these specific cancers.
How Do BRCA Genes Affect Prostate Cancer Risk?
Around 10% of all prostate cancers are linked to inherited gene changes. These are called hereditary cancers. The BRCA genes boost your odds of developing hereditary prostate cancer, especially the BRCA2 gene.
If you have a BRCA2 mutation, most studies show you may have around a 20% to 40% chance of developing prostate cancer over your lifetime. For some people, research shows the odds may be as high as 60%.
To put that in perspective, someone without this mutation has about a 16% chance of developing prostate cancer at some point in their life.
Cancer affects everyone in a different way. And many people who inherit a BRCA2 mutation won’t ever develop prostate cancer. But compared with people without this gene change, studies show that those with the variant are more likely to:
- Have an aggressive form of prostate cancer
- Develop prostate cancer before age 65
- Have cancer that comes back after treatment
- Die for reasons related to prostate cancer
There’s some evidence that people with a BRCA2 mutation who have advanced, or metastatic, disease may respond better to certain prostate cancer treatments. That includes PARP Inhibitors. But we need more research to know which treatment works best for this group.
If you have a BRCA1 mutation, your lifetime odds of prostate cancer may not go up very much or at all.
Still, there’s some evidence that a BRCA1 gene variant slightly raises your chances of developing aggressive prostate cancer before the age of 65. Your overall risk may even out with the general public as you get older. But we need more research to know for sure.
Should You Get Genetic Testing for BRCA Genes?
Talk to your doctor if you have any concerns about genetic mutations. BRCA variants are rare. But if your family history suggests it, a genetic counselor can advise whether genetic testing makes sense for you.
BRCA gene mutations don’t cause specific symptoms. Your genetic counselor or doctor will ask you some questions to find out if there’s a good chance you might have inherited one or more gene changes.
Here are some key things you’ll need to know:
- Has anyone in your family had prostate, breast, or ovarian cancer?
- How old were your family members when they were diagnosed?
- Have you had more than one blood relative diagnosed with any kind of cancer?
- Do other members of your family have BRCA1 or BRCA2 mutations?
BRCA genes are more common in certain racial and ethnic groups. People who are Ashkenazi Jewish are more likely to have either BRCA mutation compared with the general population. But certain BRCA1 mutations occur more often in non-Hispanic Black people.
Check with your insurance provider to see if they’ll pay for genetic testing. If not, some companies offer testing for free.
What About Early Prostate Cancer Screenings?
If you're aged 55 to 69, the U.S. Preventive Services Task Force (USPSTF) suggests you talk to your doctor about prostate cancer screening. But if you have a BRCA1 or BRCA2 mutation, guidelines from the National Comprehensive Cancer Network (NCCN) guidelines recommend you think about prostate screenings by age 40.
Most people with prostate cancer live a long time. But the disease can be cured if you catch it before it spreads to other parts of your body.
Your doctor can check for signs of prostate cancer before you have symptoms. That usually includes a prostate-specific antigen (PSA) blood test. Your prostate makes more PSA when you have prostate cancer. But other health problems can raise your PSA, including an infected or enlarged prostate.
Your doctor will go over the pros and cons of early PSA testing. They’ll consider your overall health and any other risk factors.
According to the USPSTF, higher-risk groups include the following:
- Ages 55 or older
- Non-Hispanic Black people
- Those with a family history of prostate cancer
Risks of testing outweigh the benefits of screening for prostate cancer in the elderly (70 and over), those who have major health problems, or those who expect to live less than 10 years.
Talk to your doctor about prostate cancer screenings if you’re in the gender-diverse community. There’s some evidence that transgender women who take gender-affirming hormone therapy have a lower risk of prostate cancer, but we need more research in this area.
What You Can Do
Lifestyle changes can lower your chances of developing prostate cancer. Healthy steps you can take include:
- Getting enough physical activity
- Maintaining a healthy body mass index (BMI)
- Eating more fruits and vegetables
- Cutting down on red meat, sugary drinks, and ultra-processed foods
If you smoke, quit. Current smokers are more likely than nonsmokers to have aggressive tumors or cancer that comes back after treatment. Smoking also raises your odds of dying from prostate cancer.
Scientists continue to study how gene changes are linked to prostate cancer. If you have a BRCA gene mutation, ask your doctor if a chemoprevention clinical trial might be right for you. These are studies that test new drugs designed to prevent people from getting cancer.