CN35 - Screening recommendations for and outcomes of male patients (pts) with germline BRCA (gBRCA)

Background

Male carriers of gBRCA pathogenic variants have a higher lifetime risk of prostate cancer (PC) and other cancers, yet limited data exists regarding optimal cancer surveillance or outcomes. We sought to understand demographics, screening recommendations and survival in male pts with gBRCA.

Methods

We conducted a retrospective review of the BC Cancer Hereditary Cancer Program (HCP) database, Canada from January 1, 2003, to December 31, 2021 of all consecutive males identified with a gBRCA. We excluded pts if gBRCA was discovered after PC diagnosis (dx). We performed descriptive statistics and univariate/multivariate analyses for overall survival (OS).

Results

Out of 505 pts, 212 were BRCA1 (42.0%) and 293 (58.0%), BRCA2. Median age was 54.6 years (range 18.0-98.1; 112 pts <40; 325 pts 40-69; 68 pts >70). 498 (98.6%) received a written consultation letter from the HCP clinics. 21 (4.2%) letters included no PC screening recommendations, while 484 did (PSA and DRE; 132 – yearly, 330 – no specific intervals). Variability in screening for other cancers was noted. Pts <40 were less likely to carry out screening than older pts (32.4 for <40 vs 65.1 for 40-69 vs 64.1% for >70, p<0.0001). 15 (3.0%) were diagnosed with PC (14 with BRCA2). 4 (26.7%) had metastatic PC and 8 (53.3%) had Gleason score>=8. Median time from gBRCA to PC dx was 34.8 months (range 0.23-201.4). Median OS from time of PC dx was 49.2 months (range 3.2-122.6). 6 underwent a clinical trial for PC. 7 pts with PC had other cancers. By cutoff date of Jun 9, 2023, 81 (16.0%) died and only 1 was due to PC. Other causes of death included pancreatic (21.0%), breast (6.2%), and gastric (4.9%) cancers. If HCP recommended screening, pts were more likely to adhere (25.0 vs. 59.5%, p=0.002). In multivariable analysis, pts who got yearly PSA/DRE recommendations had a trend towards improved OS (HR 0.28, 95% CI 0.075-1.049, p=0.059) compared to pts without. Similar trends were seen in pts with PC dx.

Conclusions

Many of male pts with germline BRCA may not undergo cancer screening. Those who receive screening recommendation are more likely to undergo screening that may improve outcomes. These data highlight the need for optimized screening and management for patients identified with gBRCA.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

K.N. Chi: Financial Interests, Personal and Institutional, Advisory Board, Research Grants: Astellas, AstraZeneca, Janssen, Merck, Novartis, Pfizer, Point Biopharma, Roche; Financial Interests, Personal, Advisory Board: BMS. S. Sun:Non Financial interest, Advisory Board: AstraZeneca, Takeda, Merck, Bristol Myers Squibb. J. Ko: Non-Financial Interests, Institutional, Advisory Board: Bayer, Astellas; Financial Interests, Institutional, Advisory Board: Eisai, Merck, BMS, Pfizer, Janssen, AstraZeneca, Takeda; Financial Interests, Institutional, Research Grant: Astellas, AstraZeneca, Bayer, Janssen. All other authors have declared no conflicts of interest.