Understanding BRCA1 and BRCA2

The BRCA genes were once again in the news this week, following results of a new drug, olaparib, which has been shown to work as an effective treatment for men with mutations in BRCA1 and 2, as well as other genes. Headlines on BRCA are familiar sight in the news by now, from their role in men’s risk of prostate cancer to using them in prostate cancer spit tests.

But what are the BRCA genes? Why is it such a problem when they change or 'mutate'? And, what does a BRCA gene mutation mean for men? 

What are the BRCA genes?

The cells in our body undergo a daily cycle of DNA damage and repair. In a normal day, the DNA in each cell can be damaged between 1,000 and 1,000,000 times. Luckily, we've evolved very efficient ways to either repair the DNA or destroy the 'broken' cells. One of these repair mechanisms are controlled by the BRCA1 and BRCA2 genes.

Because the BRCA genes are an important part of the repair process for the daily onslaught of DNA damage, any faults can mean mistakes start to build up in the DNA, which increases the chances of the cell becoming cancerous.

Do BRCA 1 and BRCA2 increase the chance of getting prostate cancer?

Mutations in BRCA1 and BRCA2 genes do increase the risk of developing prostate cancer. However, having a mutation of this type does not mean that you will get cancer – it just increases your risk slightly compared to people without a mutation.

The increase in risk is different for each gene and even mutations within the same gene probably give a different risk of someone without cancer eventually getting it. It makes this a complicated area, so we recommend you have a detailed conversation with a genetic counsellor before making any decisions about testing for inherited mutations specifically.

How can I be tested for BRCA 1 and 2 mutations?

Men with a strong family history of breast, ovarian or prostate cancer, or who have a family member with a BRCA mutation can be referred for genetic testing on the NHS, but this isn't available everywhere in the UK. There are also private clinics that don't require a GP referral. 

Genetic testing should always be accompanied by specialist counselling to help you understand the possible outcomes of the test, what the results will mean for you and your family, and how you will cope with the information the test reveals.

At the moment there's not enough evidence to say whether or not being tested for BRCA1 or 2 mutations should be done, even in men with a family history of cancer. If you have a family history of cancer and are concerned about your cancer risk, you can discuss this with your GP.

Read more about risk and prostate cancer

If I have a BRCA1 or 2 mutation, should I have regular PSA tests?

The NHS suggests that if you find out that you do have a BRCA mutation, annual PSA tests might be beneficial to give you the best chance to detect prostate cancer early if you should develop it. You can read about the pros and cons of the PSA test on our website.

The IMPACT clinical trial is happening at the moment, and is investigating whether using the PSA test to screen for prostate cancer would be good for men with a BRCA1 or 2 mutation. It's also testing how BRCA mutations affect the predicted outcome of a man's prostate cancer. Early results suggest that regular PSA testing may be beneficial for men with BRCA

Is there any evidence that BRCA1 or 2 mutations affect prostate cancer prognosis?

A recent study looked at the effect of BRCA1 and 2 mutations on prostate cancer prognosis (the predicted outcome of the disease). This study looked at men with prostate cancer, and compared those with a BRCA1 or 2 mutation and those without. The scientists found that prostate cancer in men with a BRCA1 or 2 mutation was more likely to be aggressive and to spread beyond the prostate. 

The researchers suggest that this could mean that men who are known to have a BRCA1 or 2 mutation when they are diagnosed with prostate cancer should be treated as high-risk patients immediately. However, before they can confirm these results and make a more definite recommendation, they need to wait for results of the IMPACT study.

What does BRCA have to do with breast cancer? If my mother had breast cancer do I have BRCA mutation?

You may have first heard of BRCA following news around Angelina Jolie’s decision to have her ovaries removed or a double mastectomy because she had a BRCA mutation. No. Both men and women can inherit a 'faulty' BRCA1 or 2 gene from either their mother or father.

In women, having a mutation in either BRCA1 or BRCA2 is linked to an increased risk of developing breast or ovarian cancer, and a BRCA2 mutation is thought to confer the bigger risk. Men with BRCA1 or 2 mutations are also at increased risk of developing male breast cancer, although this is still much lower than for women and very rare.

More questions about BRCA and what it means for men with prostate cancer? 

If you have any further concerns, you should speak to your GP, or our specialist nurses are available to help on 0800 074 8383.