Intensified prostate cancer screening in germline carriers of rare pathogenic variants: interim results from the initial screening round of the progress study

You have accessJournal of UrologyCME1 Apr 2023MP40-12 INTENSIFIED PROSTATE CANCER SCREENING IN GERMLINE CARRIERS OF RARE PATHOGENIC VARIANTS: INTERIM RESULTS FROM THE INITIAL SCREENING ROUND OF THE PROGRESS STUDY Keyan Salari, Alexandra Hunter, Andrew Amini, Aya Almashad, Shelley McCormick, and Linda Rodgers Keyan SalariKeyan Salari More articles by this author , Alexandra HunterAlexandra Hunter More articles by this author , Andrew AminiAndrew Amini More articles by this author , Aya AlmashadAya Almashad More articles by this author , Shelley McCormickShelley McCormick More articles by this author , and Linda RodgersLinda Rodgers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with germline pathogenic variants in prostate cancer risk genes (e.g., BRCA2) may be at increased risk of developing aggressive prostate cancer and thus warrant special considerations regarding prostate cancer screening. The Prostate Cancer Genetic Risk Evaluation and Screening Study (PROGRESS) is evaluating an intensified screening program for men at high genetic risk for prostate cancer that incorporates prostate MRI-based screening for early detection of prostate cancer. METHODS: Men between 35-75 years old with a pathogenic/likely pathogenic germline variant in one of 19 prostate cancer risk genes and no prior diagnosis of prostate cancer were prospectively enrolled. Screening paradigm included annual DRE and PSA testing and a multiparametric MRI of the prostate every three years. PSA was considered elevated using an age-adjusted threshold of >1.5 ng/mL for 35-49 years of age, >2.0 ng/mL for 50-54 years of age, and >3.0 ng/ml for 55-70 years of age. Patients with an abnormal DRE, elevated age-adjusted PSA, or a positive MRI (PI-RADS ≥3) were recommended to undergo prostate biopsy. RESULTS: A total of 81 patients have been enrolled to date, 78 of whom have completed the first round of screening. Median age is 55 years (45-64), and median PSA is 0.84 ng/mL (0.57-1.76). Most patients harbored pathogenic variants in either BRCA2 (n=31 [39%]) or BRCA1 (n=29 [37%]). After the first round of screening, 2 (3%) patients had an abnormal DRE, 10 (13%) had an elevated age-adjusted PSA, and 12 (15%) had a positive MRI. All 12 patients with an abnormal MRI, and 1 patient with a normal MRI but elevated PSA, underwent prostate biopsy. MRI was the sole indication for biopsy in 6 of the 13 (46%) patients. Eight (10%) patients were diagnosed with prostate cancer (3 BRCA1, 3 BRCA2, 1 ATM, 1 TP53), half of which were grade group ≥2. MRI-based screening did not miss any of the cancers, whereas age-adjusted PSA would have missed 7 of the 8 cancers (included 3 of the 4 grade group ≥2 cancers). CONCLUSIONS: Our early findings suggest prostate cancer is prevalent among men with high-risk germline genetic variants. MRI-based screening may enhance early detection of prostate cancer beyond PSA-based strategies in this patient population. Source of Funding: Prostate Cancer Foundation, Urology Care Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e549 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keyan Salari More articles by this author Alexandra Hunter More articles by this author Andrew Amini More articles by this author Aya Almashad More articles by this author Shelley McCormick More articles by this author Linda Rodgers More articles by this author Expand All Advertisement PDF downloadLoading ...