Approximately 1–2% of prostate cancer is due to pathogenic variants in the BRCA1 and BRCA2 genes. These show an autosomal dominant inheritance pattern.3
Multiple genetic and environmental factors are likely to influence the risk of prostate cancer. Genetic testing for gene variants in men with multiple cases of prostate cancer only in their family is not widely available.
Features suggestive of increased risk of carrying a pathogenic BRCA1 or BRCA2 variant genes include two or more relatives affected by breast or ovarian cancer on the same side of the family (maternal or paternal) plus an additional high-risk feature:4,5
- relatives with breast or ovarian cancer
- breast and ovarian cancer in the same woman
- breast cancer diagnosed <50 years of age
- Ashkenazi Jewish ancestry
- bilateral breast cancer
- male breast cancer.
A three-generation family history is key to identifying high-risk families who are most likely to benefit from genetic assessment. Such a history should include first-degree and second-degree relatives on both sides of the family, and ethnic background (eg Ashkenazi Jewish). Type of cancer (eg metachronous) and age of onset of affected relatives should be recorded where available.
In men with a family history of prostate cancer, take a family history of other cancers to assess the risk of carrying a pathogenic BRCA1 or BRCA2 variant genes. In the absence of a positive breast or ovarian cancer family history, BRCA1 and BRCA2 testing is generally not warranted.