Prostate cancer isn’t just about men, and it may be inherited. A recent study led by Peter Nelson, MD (Fred Hutchinson Cancer Research Center) has shown that 12% of advanced prostate cancers may be caused by 16 different heritable genes. That means that both men and women need to be aware of their family history of prostate cancer because it could put them at greater risk of developing breast, ovarian, and pancreatic cancers.
Breaks in DNA occur thousands of times in each cell cycle, and normal cells have several ways to prevent or repair DNA damage. However, mutations in DNA damage repair (DDR) genes can lead to the accumulation of mutations that can promote cancer formation. Most notable of these are defects in BRCA1/2 genes, which are well known for increasing a woman’s risk of breast and ovarian cancer.
The results of a recent New England Journal of Medicine article now suggest that all men with metastatic prostate cancer at diagnosis should strongly consider undergoing genetic testing for DDR gene mutations they could have inherited from their parents. Families of men found to have these DDR mutations should seek genetic counseling for all the children of the prostate cancer patient.1
Novel “Checkpoint Immunotherapy” Appears Promising in Prostate Cancer
Checkpoint immunotherapy is a revolutionary cancer treatment improving outcomes in a variety of cancers. Keytruda (pembrolizumab) is a “checkpoint inhibitor” monoclonal antibody that helps to restore the body’s immune system in fighting cancer. It creates its anti-cancer effects by blocking a specific protein used by cancer cells called PD-L1, to escape an attack by the immune system. Once PD-L1 is blocked, cells of the immune system are able to identify cancer cells as a threat, and initiate an attack to destroy the cancer. Keytruda had not been carefully studied in prostate cancer patients until 2016. Dr. Julie Graff (Oregon Health & Science University) and her team reported “exceptional prostate cancer responders” to the checkpoint inhibitor Keytruda in prostate cancer patients with Xtandi (enzalutamide) resistant cancers. Dr. Graff found that certain men with advanced, Xtandi-resistant prostate cancer exhibited responses to Keytruda treatment, with near complete reductions in prostate specific antigen (PSA) as well as resolution of metastases on CT scans.2
- Graff J, Alumkal J, Drake C, et al. Early evidence of anti-PD-1 activity in enzalutamide-resistant prostate cancer. Oncotarget. 2016; 7:52810-52817. https://doi.org/10.18632/oncotarget.10547
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