In recent years, researchers have discovered certain genetic mutations are now linked with serious diseases in men, including prostate cancer. These genetic mutations, referred to as BRCA1 and BRCA2, were previously thought solely to increase a patient's risk of breast cancer. This recent discovery has prompted doctors at Michigan Medicine, formerly the University of Michigan Health System, and specifically urological surgeon Todd Morgan, to develop the Prostate Cancer Risk Clinic — the first of its kind.

In 2012, the U.S. Preventive Services Task Force, a group of national experts that gives recommendations about clinical preventive services, gave the existing prostate cancer screening a grade D.

“The U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigen (PSA)-based screening for prostate cancer,” the recommendation read, advising against the blood test that had been used to screen for prostate cancer.

The USPSTF recommendation took prostate cancer screening out of the hands of primary care physicians, causing a drop in overall screenings for prostate cancer. This reality frightened Morgan and others in the medical field who worked specifically with patients with the disease

“A lot of us who take care of men with prostate cancer got really worried that this could lead to a significant rise in prostate cancer and men dying of (it),” Morgan said. “So there’s been a lot of thought about what we can do to prevent that from happening.”  

His eventual solution was to create the Prostate Cancer Risk Clinic at Michigan Medicine, which will open on March 15, to regularly screen patients with a genetic predisposition to the BRCA mutation or any other mutation that increases the risk of prostate cancer. Three doctors will work at the clinic. 

The PCRC’s website lists the cancer-related mutations which should prompt the scheduling of an appointment with the clinic. Besides the BRCA mutation, the clinic recommends that patients who tested positive for Lynch syndrome, Li-Fraumeni syndrome and a host of other mutations should schedule an appointment.

“The PCRC is intended for men with these mutations in order to initiate an individualized prostate cancer screening plan and follow-up care,” the clinic’s website reads.

One area that doctors are still working on is ensuring men know to get tested for the specified mutations.   

“Recommendations are totally vague still,” Morgan said. “There are a handful of recommendations that are still out there, but nothing that is broadly accepted.”

Morgan explained that patients who know they have Lynch syndrome, who have sisters or mothers with a history of ovarian, breast or pancreatic cancer or who have brothers or fathers who were diagnosed with aggressive prostate cancer will be more likely to go to genetic clinics to be tested. Morgan and his team are still working on ways to create more specific guidelines to encourage patients to receive genetic tests.   

“Over time we expect to move from just taking care of these patients with known mutations, to honing recommendations to see which men should get the genetic condition,” Morgan said.  

Clinics exist around the country to work with patients with the BRCA mutation to mitigate the risks of breast cancer. The PCRC, however, will be the first clinic with the sole goal of helping men between the ages of 35 and 70 without a prior diagnosis of prostate cancer but with a mutation putting them at risk.

If a patient is found to have a prostate cancer-related mutation, they will receive screening every year to reduce the risk of late diagnosis.

“The goal is primarily to detect more aggressive prostate cancers earlier when they are more treatable,” Morgan said.  

Morgan hopes early detection and follow-up care will lower the death rate of prostate cancer, which is currently the second leading cause of cancer deaths among men in the United States.  

In addition to annual screenings, men will be asked to discuss with their doctors anything that might be putting them at a greater risk of developing the cancer.

Morgan said he and his team are confident the creation of this clinic is an effective step in working to reduce late diagnosis of aggressive prostate cancer. The opening of the Prostate Cancer Risk Clinic at Michigan Medicine will allow for an increased prevention for prostate cancer, in turn preventing deaths.

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