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Prostate Cancer Genetic Screening

What is Prostate Cancer?

Prostate cancer is the most common cancer found in men.  It is the second leading cause of cancer death in men, yet it is highly curable if detected early.  This usually means the cancerous cells are confined to the prostate gland, meaning local treatment like surgery or radiation is highly effective.

Are All Prostate Cancers Dangerous?

No.  Many diagnosed prostate cancers are slow-growing and do not tend to spread outside the prostate, even after decades of time.  This is why men diagnosed with low-risk prostate cancer are usually closely monitored via active surveillance instead of treated.  In this population, treatment can lead to sexual dysfunction and urinary incontinence that lowers quality of life and may not even have been needed.

Some prostate cancers, unfortunately, are aggressive and can spread quickly.  These tumors must be identified and differentiated from low-risk tumors early on to ensure the highest chance for definitive cure.  A family history of a primary relative (father or brother) with prostate cancer significantly increases a man’s risk of having prostate cancer.  Also, genetic abnormalities that run in families can significantly increase the risk of aggressive prostate cancer.

HTX Urology proudly offers leading-edge genetic screening techniques not seen in most Urology clinics.  Dr. Dhir will assess your family cancer history and overall risk for genetic abnormalities to ensure that aggressive prostate cancers can be detected early and treated definitively.

The Role of Genetic Testing

Prostate cancer screening involves combining a yearly PSA (prostate specific antigen) blood test with a digital rectal exam (DRE) of the prostate.  This is done between ages 50 to 70, and screening starts earlier at age 45 in higher risk patients.  PSA testing combined with DRE helps identify prostate cancers at their earliest stages when they are confined to the prostate.  However, there are some men that should also have genetic testing performed given their risk.

In 2019, the National Comprehensive Cancer Network (NCCN) updated their guidelines on which men would also benefit from genetic testing in combination with regular screening methods mentioned above.

Men with any of the following conditions should undergo genetic testing:

  • Personal history of prostate cancer with regional spread or metastatic cancers
  • Ashkenazi Jewish Heritage
  • Brother or father diagnosed with prostate cancer before age 60, who also died of prostate cancer
  • Family history of BRCA1/2 gene mutations
  • Family history of Lynch Syndrome gene mutations
  • Family history of MLH1, MSH2, MSH6, PMS2, ATM, PALB2, or CHEK2 gene mutations

If you feel you are at risk of a more aggressive prostate cancer given the criteria above, please consult with Dr. Dhir in the office or via TeleMedicine He will ask you a comprehensive series of questions to determine if you meet these criteria and would benefit from genetic testing.

I Have Prostate Cancer, Do I Need Genetic Testing

Although most patients will get genetic testing before a possible prostate cancer diagnosis, some men with an already diagnosed prostate cancer will benefit from the same genetic testing.  These men include those that have high-risk prostate cancer, extremely high-risk prostate cancer, or have regional spread or metastatic prostate cancer disease.

These three subtypes indicate an aggressive variant of prostate cancer.  Genetic testing is important in these patients to help dictate treatment and to also inform the patient’s children and family that this genetic variant was found.  Often, family will then get genetic testing as well.

High-Risk Prostate Cancer:

  • Primary tumor stage T3a
  • Or Gleason score 8 / grade group 4
  • Or Gleason score 4+5=9 /grade group 5
  • Or PSA >20

Extremely High-Risk Prostate Cancer:

  • Primary tumor stage T3b or T4
  • Or Primary Gleason pattern 5
  • Or >4 cores with Gleason score 8 to 10 / grade group 4 or 5

What If You Have A Gene Mutation?

It is possible that after genetic screening that you will be diagnosed with a rare genetic mutation.  Furthermore, if you are eventually diagnosed with prostate cancer, you may learn that your prostate cancer was due to a specific genetic mutation.  Dr. Dhir will use this information to make an individualized treatment plan for your unique type of prostate cancer.

If a genetic mutation is uncovered, it is also important to meet with a genetic counselor.  A genetic counselor is a professional with specialized education in genetics and counseling to provide personalized help to patients that may need to make decisions based on your specific genetic mutation.  The genetic counselor can help you and your family better understand what to do with the new information you have been given about your DNA.

For more information on prostate cancer, detection, and treatment please click here.