Men who carry a BRCA gene mutation are at higher risk for breast and prostate cancer. This section provides management advice for high risk men and highlights the importance of their children being aware of the gene mutation in the family as they have a 50% chance of inheriting the gene mutation.
Men who carry a BRCA gene mutation have a slightly increased risk of developing male breast cancer and prostate cancer compared to the average man’s risk.
The level of risk of breast and prostate cancer for men with a BRCA gene mutation depends on which of the two known BRCA genes is altered. The tables below show the levels of risk compared to the average man’s risk.
Prostate cancer tends to develop earlier in men with BRCA mutations (than in the general population of men), but is still uncommon before age 50. Prostate cancers in men with BRCA2 (but seemingly not BRCA1) mutations generally grow more rapidly than in the general population. They respond differently to certain treatments compared to prostate cancer in the general population. This means it is particularly important for men with BRCA2 gene mutations to be aware of prostate cancer risk.
Managing increased cancer risks in males with a BRCA gene mutation
Even though the cancer risks are small, men who carry a BRCA gene mutation (or who have not had a gene test but are in a BRCA family) are encouraged to report any changes in the breast tissue to their doctor (GP or breast specialist ) promptly. These changes can be a hard lump, fluid or bloody discharge from the nipple or a persistent change in the skin of the nipple that makes it look puckered or scaly, for example. Assessment could require a breast specialist to examine, undergo an ultrasound and possibly biopsy the breast tissue. Lumps that develop in young men during puberty are extremely unlikely to be cancer even in men with BRCA mutations, but they are still worth having checked. They are usually caused by hormonal changes in puberty.
A general increase in the size of the breasts on both sides is not a sign of breast cancer and is not related to a BRCA mutation. It is still worth having this symptom checked with your GP to work out if this is due to a gain in fat or in breast duct tissue. Sometimes medications, alcohol or other health conditions can lead to an increase in breast duct tissue in men. Underlying causes can be treated so it is useful for a man to check with his GP if he has any worries about his breast tissue.
Men with BRCA mutations are recommended to consider a yearly PSA (blood test) to screen for prostate cancer from age 40 (EVIQ). Some doctors will also offer a yearly rectal examination of the prostate gland to assess the size, shape and texture of the prostate. If a man has symptoms such as problems with slow urine flow, frequent urination or difficulty starting or stopping urine flow, then a prostate examination will be a useful part of the assessment. If a man does not have symptoms, then it is less clear whether a rectal examination will add useful information. The doctor can discuss the pros and cons of a rectal examination. It is useful to know that a rectal examination can cause a PSA blood test level to increase transiently. This examination does not damage the prostate but it means that if a man is going to have both a PSA and a rectal examination, it is preferable to have the PSA blood test before the examination rather than the other way around, to reduce the possibility of needing a repeat PSA blood test.
PSA blood levels can fluctuate for many other non-cancer reasons such as urinary tract infection, benign enlargement of the prostate gland and also activities such as sex or cycling. If a PSA blood level is raised, it is usually repeated by a urologist often in a matter of weeks to see if it remains increased, before a decision is made on the next step. The approach to investigations depends on factors such as the gene involved, the man’s age, the level of the PSA test and whether there are any symptoms.
Children of Males with a BRCA gene mutation
Men and women can equally inherit and pass on breast cancer gene mutations to their male and female children. This means the children of men have a 50% (1 in 2) chance of having inherited the BRCA gene mutation from their father. Inheriting a single BRCA gene mutation from a parent does not cause a risk of cancer in childhood.
It is important for men to be aware that there are health risks for any of their descendants who inherit the mutation, once they reach adulthood. This is particularly important for their female descendants because they will have higher risks than men. It is common for men and women to find it a challenge to discuss genetic information. So if a person is considering talking to his family about any issues related to BRCA genes, testing or results and they are unsure of how to have that conversation they may like to talk with a Familial Cancer Clinic or read the talking to children or other relatives sections in this pack.