Hereditary PCa

I am not sure if being inherited really matters in the treatment choice. In my family me and both my brothers likely have PC. I was Dx a year ago and our middle brother was DX two years ago. Our oldest brother is having a biopsy in 2 weeks and we fully expect to find PC (because of symptoms, DRE and PSA). One bother had surgery and I had IGRT. A year after treatment and we're both doing just fine, very low PSA and few side effects. Our older brother will likely get HT if it gets anything (lots of issues with his case that out of the scope of your question).

The question for me is - is there a real genetic link or is it all because of environment? Or a combo. There are no other men in our family that have PC, except us three brothers (no fathers, grandfathers, uncles, etc). However all three of is live within 5 miles of each other (and have for our whole lives) and all ate about the same bad diet from childhood.

Reoccurrance wasn't a consideration for me since I've got enough other health issues that are just as likely to kill me over the same time span that PC could reoccur so I pick one that had the least side effects and the least risk of making my other problems worse.

and I've improve my diet and get much more exercise.

Just some of my thoughts.
All the best,
Andrew

I agree that there are going to be some prostate cells or tissue of some sort remaining after surgery. My train of thought is that there would be much more prostate tissue left following brachy rather than surgery. Given time (15-20 years), this prostate tissue would be more suseptible to becoming cancerous based on genetics/environmental factors. I'm thinking the more prostate left the higher the chances of a reoccurrance - I may just be off in left field.....

I really have no idea if it makes any difference at all with treatment choices and long-term outcome; I have not found any information indicating one way or the other.

Thanks for your opinions and insight.

I just had a conversation with Dr. Peter Carroll at UCSF about the general question of the usefulness of genetic or molecular profiling in making treatment decisions. My situation is a little different from yours in that my prostate has already been removed and is available in storage, available to be analyzed. But the general answer might be helpful for you. Dr. Carroll said there is currently *no* research to indicate that for people with certain genetic factors or biomarkers, that some treatments work better than others. There is no evidence to support using genetic information to make differential treatment decisions. He said they are starting to do some research at UCSF about prognostic implications of biomarkers i.e. if you have genetic pattern "X" in your prostatectomy specimen, that you might have a better or worse chance of permanent remission than someone without that pattern. But this research is not finished or published yet. And it is only prognostic information, it does not yet get into the question of what treatments work best for which genetic patterns.

So I agree with you that your hunch is plausible, but there is no data either way on it.

You could always have some genetic testing done, and if you have certain conditions it might tip you one way or another. But that costs money and insurance may not pay for it. So if I were in your shoes, unless I got a genetic profile done, and unless it showed strong evidence one way or the other way, I would not consider your familiar disease pattern as anything more than a tie-breaker in decision-making.

If you are of eastern european Jewish background you might want to get tested for the BRCA mutuation. If you have it, it there is a greater chance of having prostate cancer (I forget if this applies to BRCA1 or BRCA2 or both) and a greater chance that the cancer will be aggressive. That might influence the decision. I think the BRCA test costs about $3K if you have to pay for it out of pocket.

Good luck with your decision.

Good luck with your decision.

Prostate cancer can be inherited through the maternal line as it was for my husband.

I originally read this in Ds Strum’s book and did some research on this. The paper “The complex genetic epidemiology of prostate cancer” by Daniel J. Schaid states the following:

“Hereditary prostate cancer has been defined by Carter et al. (50) as families that meet at least one of the following three criteria: (1) a cluster of three or more relatives affected with prostate cancer in any nuclear family; (2) the occurrence of prostate cancer in each of three successive generations in either of the proband's paternal or maternal lineages; or (3) a cluster of two relatives, both affected with prostate cancer at 55 years of age or younger. This definition is somewhat biased towards autosomal dominant transmission, and would likely miss some families with autosomal recessive or X-linked transmission. Nonetheless, it has been an operational definition used in a large number of studies, particularly those focused on linkage. In an effort to discriminate between hereditary and non-hereditary forms of prostate cancer, a number of investigators have applied the Carter criteria to prostate cancer cases, in order to explore the clinical features that might discriminate between genetic and non-genetic forms of this disease. No clinical or pathologic characteristics have been found to differ between hereditary and non-hereditary forms of prostate cancer (50,51), and the main difference is an earlier age of diagnosis for hereditary prostate cancer, 6–7 years (51).“

The “proband” is the person in question – e.g. my husband.

Given your relatively young age it would seem even more likely that it is inherited. I read somewhere that around 50% of men diagnosed with prostate cancer under the age of 55 are suspected to have a hereditary disease. Although it means little to the way you treat it, the important thing here is for your brothers and cousins to keep an eye on their psa numbers.

An

Post Edited (An38) : 2/9/2013 11:03:32 PM (GMT-7)