Patients with prostate cancer and BRCA2 mutations need urgent treatmentBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2223 (Published 09 April 2013) Cite this as: BMJ 2013;346:f2223
All rapid responses
the increasing presence of molecular studies in overall management guidelines of diseases but particularly cancers is encouragiong and one can only wish for more.
prostate cancer is a major clinical problem and like many cancers, perhaps even more so than many, its treatment can have game-changing impact on the lives of victims;
evidence based studies are now suggesting that some of the diagnosed cases of prostate cancer need no more than active surveillance instead of heavy-handed treatment modalities that tend to make cure of the disease worse than the disease itself.
the clinical dilemma has always been to identify markers that carry sufficient discriminant capabilities that can guide clinicians faced with these patients, which ones to route into aggresive management pathways and which to subject to kid gloves.
that BRCA1/2 are promising to provide windows thro which the clinician can see a selective path in these regards is reassuring.
as always though, such genetic screening with 'epidemiologic' applicability in all prostate cancers may still be the precincts of only few privildged well resourced centres;
in many parts, diagnosis will stop only at histopathology level (if) and what follows is left to discretionary decisions on the part of clinicians or and patients.
there is therefore an understandable hurry on the part of clinicians to have molecular aids like these close to the bed sides so a broader impact is allowed; be these for prostates or breast or ovaries.
it may also be more fulfilling to have an idea what predisposes the brca gene to such mutation/damage in these cohorts.
i am beginning to see in my broader practice, increasingly younger age at onset of prostate cancers; so far application of brca screening is still unapplied in this setting, and so any biologic variance that may attend age incidence patterns ( outside of observational studies) is still uncertain from these perspectives .
Competing interests: No competing interests