
Pros and cons of genetic testing for prostate cancer
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For one thing, the gene is very large and can have a number of different mutations. Some are going to be more lethal than others and some will not be harmful at all. As Brawley tells it,
every man thinking about using genetic testing to screen for mutations that cause prostate cancer “needs to think about if he is the one in 1,000 that will benefit from it and have his life
saved, or if he will be one of the 40 in 100 that will be harmed by being identified as having prostate cancer that he didn't need to know he had.” From testing for a cancer that can be
so slow moving as to never shorten a lifespan, men may wind up with physical harm due to unnecessary biopsies which carry a risk of infection and sepsis, not to mention pain. They can also
develop anxiety and other mental health problems from the thought of having cancer, not to mention possibly suffer from economic hardship and insurance discrimination, Brawley notes. A BRCA2
mutation is the most common type that can lead to prostate cancer. If you are tested and find out you do have such a mutation, Mohler says it shouldn't be cause for grave concern.
Having it, Mohler says, “makes you a little more likely to develop prostate cancer — and if you develop it, it may make [the cancer] a little more aggressive." Those with a BRCA2
mutation, he says, should just be more rigorously followed with annual PSA testing (conducted via a blood test) and an annual prostate exam, and potentially begin screening for the disease a
little earlier than guidelines suggest, at age 35 or 40, he noted. "It's very hard to make guidelines for everyone across the spectrum. That's because he said the prostate
cancer field is somewhat behind the breast cancer field at this time,” he says. Right now, the person who Mohler says should get genetic sequencing would be someone with a strong history of
prostate cancer in more than one first-degree relative (parents, full siblings, children), or who has had a family member who died of prostate cancer, especially at a young age, or if they
are of Ashkenazi Jewish descent. If someone has metastatic prostate cancer, or a high-grade or aggressive cancer, then they should also probably think about getting genetic testing as well.
"Genetic testing is very complicated and we're very much at the beginning of knowing who should have these tests and how the information should be used. Most importantly, we need
to learn if any treatment changes based on genetic testing is going to affect prostate cancer survival,” Mohler says.