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Primary Care

Presentation: Patient with a family history of prostate cancer

Prostate cancer affects one in eight men in the UK, with around 5% of cases connected to a cancer predisposition syndrome. A family history of prostate cancer increases an individual’s risk of developing it themselves.

At a glance:

  • Prostate cancer affects one in eight men in the UK, with only around 5% of cases being connected to cancer predisposition, such as BRCA1– or BRCA2-associated cancer predisposition or Lynch syndrome.
  • The NICE guidance on familial breast cancer and related cancers outlines eligibility criteria for genomic testing (such as BRCA1 and/or BRCA2 testing) in those with a relevant Manchester score.
  • Testing would be instigated as appropriate following assessment in secondary care or clinical genetics services.
  • Alert! Men with a brother or father with prostate cancer are 2.5 times more likely to develop prostate cancer; this likelihood increases further if the father or brother was younger than 60 years old when diagnosed.

Example clinical scenario

A 53-year-old man attends an appointment with his GP worried about his family history. His brother has recently been diagnosed with prostate cancer at the age of 51. On closer questioning, he reveals that his sister was diagnosed with breast cancer at the age of 32.

Identifying those at risk of a genetic condition

  • Prostate cancer can be associated with variants in BRCA1 and BRCA2 and with certain variants causing Lynch syndrome (MSH2 and MSH6).
  • Males with a pathogenic BRCA1 or BRCA2 variant have an increased chance of developing a more aggressive prostate cancer.
  • Flags for an underlying genetic diagnosis include:
    • early age of cancer diagnosis (prostate cancer at below the age of 60);
    • individuals who present with more than one associated cancer (for example prostate, breast, ovarian, endometrial and bowel cancer);
    • multiple close relatives with genetically associated cancers (such as colorectal, breast, ovarian and endometrial cancer); and
    • Ashkenazi Jewish heritage.

What do you need to do?

  • If your patient has a family history that suggests a cancer predisposition syndrome, refer them to secondary care or clinical genetics for consideration of genomic testing.
  • If your patient has a strong family history of breast and/or ovarian cancer, you may also wish to consult Patient with a family history of breast and/or ovarian cancer.
  • Management in primary care should include:
    • advising the patient about suspicious symptoms to be aware of, with early clinical examination if indicated – for example, rectal examination or breast examination;
    • addressing lifestyle factors such as smoking and alcohol consumption;
    • managing patient anxiety;
    • advising the patient to return if their family history changes; and
    • providing information regarding screening programmes: current guidance does not support regular prostate-specific antigen screening in those at increased risk of developing cancer due to family history or an underlying cancer predisposition syndrome. This may change with respect to men with BRCA2 variants as evidence continues to emerge.
  • Information about patient eligibility and test indications were correct at the time of writing. When requesting a test, please refer to the National Genomic Test Directory to confirm the right test for your patient.

Resources

For patients

References:

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  • Last reviewed: 01/06/2023
  • Next review due: 01/06/2024
  • Authors: Dr Imran Rafi
  • Reviewers: Dr Asma Hamad, Dr Jude Hayward

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