Hirslanden Fachartikel

Family history plays a major role in prostate cancer. Men can determine their individual level of risk by seeking genetic advice and undergoing testing. Their family tree will already provide some answers: there is important information contained not only in their father’s and grandfather’s medical histories, but also in those of their female relatives, says Prof. Dr. med. Thomas Szucs, Co-Director of Hirslanden Precise.

We didn't truly become aware that the predisposition for breast cancer is hereditary until Angelina Jolie’s case. What role do our genes play in prostate cancer?
An extremely important one! It's also possible to establish a family connection through the patient’s medical history in about 20 per cent of cases when it comes to prostate cancer. That means relatives of every fifth patient already have the disease. The latest data from analysed tumours shows that there are genetic variants in around 10–15% of all tumours. 

Are there indications of genetic predisposition without genetic testing?
Yes. In this case, two factors play a role: prostate cancer has appeared in relatives under the age of 65, or prostate cancer has occurred in three subsequent generations. We examine both the paternal as well as the maternal line to see whether prostate cancer occurred in the father or grandfather. In this case, the age of the affected person isn't an issue.

How long have we known that prostate cancer is also hereditary?
We've known this for a long time. However, we've recently started to gain a better understanding of the genetic structure of the tumour. We're increasingly finding interesting genetic variants whose role we need to re-examine. This includes, among others, the genetic mutation BRCA2, or to put it another way, the Angelina Jolie gene. We know that around every fifth case of prostate cancer can be traced back to a BRCA2 mutation. However, we also now know that other genes play a part in the development of prostate cancer. This means we’re just starting out on a long, exciting journey.

Who benefits the most from a genetic test?
There are three clinical indications that point to the need for a genetic test: Firstly, when prostate cancer has occurred in several members of the family. Another strong indication is when a relative under the age of 65 has fallen ill with prostate cancer. A third indication is when other cancers, in particular breast cancer or ovarian cancer, have occurred in the family. I always ask about this. The doctor should also look at the medical history of the women in the patient’s family when determining his risk of contracting prostate cancer.

What's the benefit of knowing that I carry such a genetic mutation?
In these cases, it's possible to take extremely specific measures and look at the situation more closely before anyone actually contracts the disease. We usually recommend more intensive preventive measures. Here too, there are new high-tech examinations. For example, a multiparametric MRI. This is a special MRI examination of the prostate. As there is no rectal examination, it is far more precise. If the results are positive, the doctor performs a biopsy. As I mentioned earlier, the MRI enables us to take a more targeted approach.

And what benefits does genetic analysis offer for those who already have prostate cancer?
Genetic analysis may open up new treatment options for those who already have the disease. If a patient is found to have the corresponding genetic mutation, drugs can be prescribed which have already been used successfully for breast cancer patients, for example. Tumour therapy is no longer organ-specific. We treat the genetic variant rather than the organ, which opens up entirely new treatment opportunities in this area.

There's considerable demand from women who would like to have their breast cancer risk assessed at Precise. Which men come to your practice?
With regard to prostate cancer, the majority of our patients are men who're making provision for their retirement and want to know whether they're genetically predisposed to contracting the disease. However, there are also patients who already have cancer and would like to protect their relatives. Then we examine the family tree and determine whether there is actually a high-risk situation in the family. In these cases, we recommend that relatives who don't yet have the disease undergo the corresponding preventive check-ups.

What is the procedure for a genetic test at Hirslanden Precise ?
During the preliminary consultation, we compile the patient’s family tree. In the process, we not only look for prostate cancer but also for other risks. If there are indications of a family history of the disease, the patient will undergo a BRCA2 test, among other things. We have to adhere to the corresponding guidelines for these tests.

Are these genetic tests also covered by the mandatory health insurance ?
A genetic test costs around CHF 4 000 and is usually covered if a patient has corresponding risk factors. However, there must be clear evidence of a family history. In the majority of cases, we have to request a commitment to cover costs as genetic tests aren't usually included under the Medical Benefits Ordinance (KLV). To this end, we discuss the cases in an interdisciplinary genomic board. Sometimes we also determine the likelihood of a mutation using mathematical models. If the health insurer agrees, we identify the gene with a blood test and search for mutations that could facilitate the occurrence of prostate cancer.