Presentation Authors: David Margel*, Sivan Sela, Shlomit Tamir, Inbal Kedar, Yaara Ber, Daniel Kedar, Andrei Nadu, Jack Baniel, Petah-Tikva, Israel
Introduction: Male BRCA germline mutation carriers are at high risk for prostate cancer. IMPACT study results support routine PSA screening among BRCA carriers. Guidelines for female BRCA carriers include breast MRI as part of routine cancer screening. In this study we examine the use of MRI as a screening tool for prostate cancer among male BRCA carriers.
Methods: We prospectively enrolled 185 male BRCA carriers age 40-70, between April 2014-July 2018. We performed the following screening for all male BRCA carriers: DRE, PSA and multi-parametric prostate MRI. We performed MRI-US fusion biopsies to any suspicious lesion.
Results: Of the 185 BRCA carriers included, 107 had a BRCA1 mutation (58%) and 78 BRCA2 mutations (42%). Median age was 52.7 (IQR 45-63). All patients underwent PSA and DRE. MRI was performed by 176 (95%). Median PSA was 1 (IQR 0.6-1.7). Twenty-eight carriers had a PSA above 3 (cutoff for biopsy in the IMAPCT study). Eighty-nine carriers had an MRI lesion (PIRADS2- 27, PIRADS3- 32, PIRADS4- 25, PIRADS5- 5). We performed prostate biopsy for 86 patients. Sixteen patients were diagnosed with prostate cancer (8.5%). Of these, 50% had significant prostate cancer (Gleason grade 7 or above). All significant prostate cancers were detected by MRI-US fusion biopsies. Eighty-five carriers included were under the age of 50. Among these, we detected prostate cancer in one carrier (1%). Conversely, prostate cancer was detected in 15% (10 out of 69) among carriers over the age of 60. The negative predictive value of prostate MRI was 100% (PIRADS3 and above were considered positive). However, its positive predicted value was only 24%.
Conclusions: Prostate cancer screening for male BRCA carriers should start at age 50. MRI should not be used as a screening modality for prostate cancer, and may lead to many unnecessary biopsies. Elevated PSA levels or abnormal DRE should be followed by an MRI to diagnose significant prostate cancer. Future biomarkers may improve screening protocols in this high-risk population.
Source of Funding: ASCO Career Development Award 2015