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Considering genetic risk in prostate cancer referrals could lead to earlier diagnosis

Men at the highest risk for prostate cancer could be fast-tracked for investigation if their genetic risk was considered in general practice, new research has concluded.

A large-scale study by the University of Exeter, published in the British Journal of Cancer, looked at the impact of incorporating genetic risk for cancer into the GP triage and referral processes. The research concluded that considering genetic risk could improve referrals for those in need — and importantly, avoid invasive biopsy investigations for those at low risk of cancer. Assessing genetic risk in primary care could lead to earlier diagnosis for men most at risk of prostate cancer.

Prostate cancer accounts for around a quarter of new cancer cases in men — approximately 52,000 men are diagnosed per year in the UK alone. It is the second most common cause of cancer death in men in the UK, and five-year survival doubles if it’s diagnosed at an early stage compared to advanced stage. Symptoms are common and easily misdiagnosed, and an estimated 14 per cent of prostate cancer deaths could be avoided if they were diagnosed earlier.

GPs make around 800,000 suspected prostate cancer referrals annually in the UK. The research team estimate that incorporating genetic risk for cancer into GP triage could mean 160,000 men could be expedited for faster investigation, while 320,000 of these could safely avoid referral and unpleasant investigation.

Lead author Dr Harry Green, independent Research Fellow at the University of Exeter Medical School, said: “Our study is the first to demonstrate that incorporating genetic risk into GP’s risk assessment of patients’ symptoms of possible prostate cancer could result in faster referral for those at most risk.”

At the moment, a prostate Specific Antigen (PSA) test is used to investigate men with erectile dysfunction or urination problems, but the accuracy of the test is unclear, and false positive results are common. Only one in three men with a positive PSA test have cancer. An invasive and unpleasant biopsy is often needed for diagnosis. Research shows the PSA test can miss around 15 per cent of cancers.

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