Natalie Taylor

The PROFILE Feasibility Study: Targeted Screening of Men With a Family History of Prostate Cancer

A better assessment of prostate cancer (PrCa) risk is needed to improve screening. The PROFILE pilot study explored the feasibility of single nucleotide polymorphism profiling in men with a family history (FH) of PrCa to investigate the probability of detecting PrCa at prostate biopsy (PB). The results of the present pilot study have demonstrated that PB is a feasible and safe method of PrCa screening in men with a FH.

Baseline results from the UK SIGNIFY study: a whole-body MRI screening study in TP53 mutation carriers and matched controls

In the United Kingdom, current screening guidelines for TP53 germline mutation carriers solely recommends annual breast MRI, despite the wide spectrum of malignancies typically seen in this group. This study sought to investigate the role of one-off non-contrast whole-body MRI (WB MRI) in the screening of asymptomatic TP53 mutation carriers. 44 TP53 mutation carriers and 44 population controls were recruited. Scans were read by radiologists blinded to participant carrier status. The incidence of malignancies diagnosed in TP53 mutation carriers against general population controls was calculated. The incidences of non-malignant relevant disease and irrelevant disease were measured, as well as the number of investigations required to determine relevance of findings. In TP53 mutation carriers, 6 of 44 (13.6, 95% CI 5.2–27.4%) participants were diagnosed with cancer during the study, all of which would be considered life threatening if untreated. Two were found to have two primary cancers. Two participants with cancer had abnormalities on the MRI which were initially thought to be benign (a pericardial cyst and a uterine fibroid) but transpired to be sarcomas. No controls were diagnosed with cancer. Fifteen carriers (34.1, 95% CI 20.5–49.9%) and seven controls (15.9, 95% CI 6.7–30.1%) underwent further investigations following the WB MRI for abnormalities that transpired to be benign (p = 0.049). The cancer detection rate in this group justifies a minimum baseline non-contrast WB MRI in germline TP53 mutation carriers. This should be adopted into national guidelines for management of adult TP53 mutation carriers in addition to the current practice of contrast enhanced breast MRI imaging.

The psychological impact of undergoing genetic-risk profiling in men with a family history of prostate cancer

The ability to identify men at genetically high‐risk of prostate cancer (PrCa) would enable screening to be targeted at those most in need. This study explored the psychological impact (in terms of general and PrCa‐specific worry and risk perceptions) on men with a family history of PrCa, undergoing prostate screening and genetic‐risk profiling, within a research study.

It's all very well reading the letters in the genome, but it's a long way to being able to write: Men's interpretations of undergoing genetic profiling to determine future risk of prostate cancer.

A family history of prostate cancer (PC) is one of the main risk factors for the disease. A number of common single nucleotide polymorphisms (SNPs) that confer small but cumulatively substantial risks of PC have been identified, opening the possibility for the use of SNPs in PC risk stratification for targeted screening and prevention in the future. The objective of this study was to explore the psychosocial impact of receiving information about genetic risk of PC. The participants were men who had a family history of PC and were enrolled in a screening study providing research genetic profiling alongside screening for PC. A combination of questionnaires and in-depth interviews were used. Questionnaires were completed by men at two time points: both before and after joining the study and going through the genetic profiling process. The interviews were completed after all study process were complete and were analysed using a framework analysis. In total 95 men completed both questionnaires and 26 men were interviewed. A number of issues facing men at risk of PC were identified. The results fell into two main categories: personal relevance and societal relevance. The strength of men’s innate beliefs about their risk, shaped by genetic and environmental assumptions, outweigh the information provided by genetic testing. Men felt genetic profile results would have future use for accessing prostate screening, being aware of symptoms and in communicating with others. The findings reinforce the importance of providing contextual information alongside genetic profiling test results, and emphasises the importance of the counselling process in providing genetic risk information. This research raises some key issues to facilitate clinical practice and future research related to the use of genetic profiling to determine risk of PC and other diseases.

MP07-05 SERUM TESTOSTERONE AS A BIOMARKER FOR PROSTATE CANCER DIAGNOSIS IN THE IMPACT POPULATION

INTRODUCTION AND OBJECTIVES: The relation of serum androgens and the development of prostate cancer (PCa) is subject of debate. Lower total testosterone (TT) levels have been associated with increased PCa detection and worse pathological features after treatment. The aim of this study is to investigate the association of serum androgens levels and PCa detection in a prospective screening study of men at higher genetic risk due to BRCA mutation METHODS: Six hundred and fifty seven participants in the IMPACT study had sequential TT and sexual hormone binding globulin (SHBG) measurements in serum samples at annual visits, giving 2783 prospective androgen levels, from 234 BRCA1 carriers, 268 BRCA2 carriers and 155 mutation negative controls. Free and bioavailable testosterone were calculated from TT and SHBG using the Sordergaard equation. Age, BMI, PSA and hormonal concentrations were compared between men affected and unaffected with PCa within each genetic cohort using unpaired t-test. The Fisher exact test was used to correlate hypogonadic levels of testosterone and genetic status with PCa diagnosis within each genetic category RESULTS: There were no significant differences in the PSA levels and BMI at study entry. Mean ages were 53.52, 52.17, and 51.17 years, for the control, BRCA1 and BRCA2 groups, respectively (BRCA1 p1⁄40.24 and BRCA2 p1⁄40.01). In the BRCA2 cohort, serum TT levels were lower in carriers diagnosed with PCa, compared with unaffected carriers and controls (11.2, 13.78, 13.4 nmol/L, mean values per group, respectively, p1⁄40.02 and p1⁄40.009). In the BRCA1 cohort, no significant difference was observed between affected and unaffected carriers and controls (13.6, 13.5, 13.4, nmol/L, mean values per group respectively, p1⁄40.82 and p-0.69). SHBG levels were significantly higher in BRCA1 carriers with PCa than unaffected carriers and controls (47.62, 37.97, 40.34 nmol/L, respectively; p1⁄40.002 and p1⁄40.03). TT levels <8nmol/L were significantly more frequent among BRCA2 carriers with PCa then unaffected carriers and controls (OR 2.78, 95% CI: 1.3-5.8, p1⁄40.01). This finding was not observed in the BRCA1 cohort. There was no significant difference in the levels of free and bioavailable testosterone in both cohorts CONCLUSIONS: Our findings indicate that there is a difference between BRCA1 and BRCA2 carriers who develop PCa in relation to serumTT and SHBG levels. BRCA2 carriers affected with PCa had lower total testosterone levels, and affected BRCA1 carriers had higher levels of SHBG. These data are preliminary but may indicate that these values could be explored as biomarkers for BRCA-related prostate cancer

The PROFILE feasibility study: Genetic prostate cancer risk stratification for targeted screening.

22 Background: Prostate cancer (PC) screening is controversial and a better assessment of individualized PC risk is needed. Several single nucleotide polymorphisms (SNPs) conferring a cumulative risk of PC have been identified. We have explored the potential role of genetic markers for targeted screening in a population with increased risk of PC due to family history (FH). Methods: PROFILE was developed as a pilot study to determine the feasibility of targeted PC screening using prostatic biopsy (PB) and its association with specific genetic profiles in men with FH. We also evaluated the role of PSA and Diffusion Weighted MRI (DW-MRI) as screening tools. One hundred sixteen men age 40 to 69 with FH of PC were enrolled between October 2009 and December 2012. Cumulative SNP risk scores were calculated by summing 59 risk alleles for each locus using the weighted effect (log-additive model). DW-MRI was performed in 50 patients. Participants were asked to undergo a 10 core PB regardless of baseline PSA. Result...

Abstract 262: The PROFILE feasibility study: Genetic prostate cancer risk stratification for targeted screening

Introduction & Objectives: Prostate cancer (PC) screening is controversial and a better assessment of individualized PC risk is needed. Several single nucleotide polymorphisms (SNPs) conferring a cumulative risk of PC have been identified. We have explored the potential role of genetic markers for targeted screening in a population with increased risk of PC due to family history (FH). Material & Methods: PROFILE was developed as a pilot study to determine the feasibility of targeted PC screening using prostatic biopsy (PB) and its association with specific genetic profiles in men with FH. We also evaluated the role of PSA and Diffusion Weighted MRI (DW-MRI) as screening tools. 116 men aged 40-69 with FH of PC were enrolled between October 2009 and December 2012. Cumulative SNP risk scores were calculated by summing 59 risk alleles for each locus using the weighted effect (log-additive model). DW-MRI was performed in 50 patients. Participants were asked to undergo a 10 core PB regardless of baseline PSA. Results: Median age 53 yrs (40-69) and median PSA was 1.15. One hundred and two men accepted to undergo a PB as primary PC screening. Twenty-three tumours were found (22.5% of biopsies) as well as seven men diagnosed with atypical small acinar proliferation (ASAP) (6.8%) and 8 men with high-grade prostatic intraepithelial neoplasia (HG-PIN) (7.8%). In total 37.1% received an abnormal result. Of those diagnosed with PC, 41% were intermediate or high risk and required treatment (compared to 24% in general population screening). The predictive performance of DW-MRI, PSA, genetic model and genetic model plus PSA measured by AUC were: 0.85, 0.73, 0.57 and 0.74, respectively. The genetic model performed best in men with a ‘normal’ PSA ( Conclusions: Our results indicate that PB used for PC screening in men with FH of PC identified a higher proportion of clinically significant PCs. The high AUC for DW-MRI would warrant a larger study. The incidence of ASAP is higher in this group than the general population.The SNP risk score was more predictive in men with PSA Citation Format: Rosalind Eeles, Zsofia Kote-Jarai, Antonis Antoniou, Pardeep Kumar, Christos Mikropoulos, Tokhir Dadaev, Natalie Taylor, Elizabeth Bancroft. The PROFILE feasibility study: Genetic prostate cancer risk stratification for targeted screening. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 262. doi:10.1158/1538-7445.AM2014-262

Identification of men with a genetic predisposition to prostate cancer: Targeted screening in men at higher genetic risk and controls--The IMPACT study.

12 Background: IMPACT is a multi-national targeted prostate cancer screening study of men with a known germline mutation which is thought to predispose to the disease. The study is recruiting male BRCA1/2 mutation carriers and a control group, who have tested negative for a mutation present in their family, from 52 centres in 17 countries. METHODS Eligible men aged 40-69 years are offered annual serum PSA testing for at least five years. The PSA threshold used to determine prostate biopsy is >3ng/ml. All men are offered a biopsy irrespective of PSA level after 5 years of screening. Men are also invited to take part in a Quality of Life sub-study. RESULTS To date 1819/ 1850 men have been recruited (593 BRCA1, 580 BRCA2, 638 Controls). 213 presented with a PSA ≥3ng/ml and 159 biopsies have been performed (54 men have either declined the biopsy or are awaiting results) and 60 men have been diagnosed with prostate cancer (31 BRCA2 carriers, 16 BRCA1 carriers and 13 controls). 45% of cases diagnosed in BRCA1/2 carriers were Gleason score ≥7. The estimated positive predictive value (PPV) for PSA screening in Controls was 28%, similar to that in the general population, whilst it was 36% for BRCA1 and 46% for BRCA2. CONCLUSIONS Our preliminary results show that annual PSA screening using a cut-off of 3.0ng/ml detects aggressive prostate cancer in BRCA carriers. Early data indicate that a larger proportion of gene carriers have developed clinically significant prostate cancers (those that would need radical treatment on UK treatment guidelines) compared with the control group. The higher risk of PrCa observed in BRCA1 and BRCA2 carriers will need to be confirmed with further data Acknowledgements: The IMPACT study collaborators and participants, The Ronald and Rita McAulay Foundation, Cancer Research UK, NIHR. CLINICAL TRIAL INFORMATION NCT00261456.