Predicting Prostate Cancer

Just a few years ago it would have been unimaginable that a woman might choose to remove her breasts and/or ovaries in an attempt to prevent breast or ovarian cancer. With the dramatic advances in our understanding of cancer genetics we are now able to identify those at increased risk and equip them with the information to make such a decision, a decision that could save their lives and those of family members. Angelina Jolie brought awareness to the world in her decision to remove her breasts and ovaries because she carries the cancer causing BRCA gene mutation. Who will be the first for prostate cancer and when will this occur? It may be sooner than you think.

A recent study out of UCSF-Kaiser Permanente studied 7,783 men with prostate cancer, comparing them to 38,595 without cancer.Researchers looked at 105 different DNA variants and found certain combinations of these variants that predicted which men would develop prostate cancer. In fact, men at the highest risk had a cancer risk comparable to women’s breast cancer risk carrying the well known BRCA gene mutations.

This comes on the heels of another study identifying potential actionable targets for prostate cancer and shedding light on what drives prostate cancer. An international group of researchers looked at 150 men with metastatic, advanced prostate cancer that had become resistant to treatment. They found almost two thirds had mutations in the male hormone androgen receptor. Nearly a quarter had mutations in DNA repair genes including BRCA. This may allow for drugs approved in other BRCA driven cancers to be usedin patients with advanced prostate cancer. Additionally, eight percent of patients had a heritable mutation, raising the possibility that some forms of prostate cancer are inherited and genetic counseling may be of benefit.


Why is this important? Consider these facts on prostate cancer.More than 200,000 men will develop prostate cancer this year, making it the #1 cancer in men after skin cancer. Almost 30,000 men will die of prostate cancer, second only to lung cancer. The statistics on prostate cancer are strikingly similar to breast cancer. Men may soon have available the same genetic testing options that women do to predict risk of cancer. It may not be unrealistic to expect a future where prophylactic prostatectomy will be an option for some, just as removal of breasts and ovaries are for women with a genetic predisposition to cancer is being done today.

Studies such as these where specific characteristics of tumors are compared to those without cancer allow for identification of markers that may predict cancer or even yield valuable information on treatment choices for those with cancer. This new approach to cancer is termed personalized or precision medicine and has revolutionized cancer care.

Pathologists play a major role in precision medicine. They are instrumental in the diagnosis and testing for the presence of actionable mutations in tumors that allow matching the right drug to the right patient at the right time. Many of the new and emerging biomarkers for prostate cancer have been developed with the help of pathologists. 

What can you do?

- Understand your risk factors.

- Know your family history.

- Visit the Samadi Robotics Foundation to learn more.

Take control of your health. It is through informed decision making with your doctor that will ensure your continued health.



Dr. Michael Misialek currently serves as Associate Chair of Pathology at Newton-Wellesley Hospital, Newton, MA. He is the Medical Director of the Vernon Cancer Center, Chemistry Laboratory and Point of Care Testing. He practices in all areas of pathology in a busy community hospital. Holding an academic appointment at Tufts University School of Medicine as a clinical assistant professor of pathology, he regularly instructs medical students and pathology residents. Dr. Misialek is a strong advocate for pathology and is very active in the College of American Pathologists (CAP), serving on the Personalized Healthcare Committee, the political action committee PathPAC, the CAP Foundation and as chair of the Massachusetts delegation in the CAP House of Delegates. He is an inspector with the CAP and has conducted several domestic and international hospital laboratory inspections.

He received his MD from the University of Massachusetts, did an internship in internal medicine at Boston Medical Center and completed his residency in anatomic and clinical pathology at the University of Massachusetts Medical Center. He did a fellowship in general surgical pathology at the University of Florida and is board certified in Anatomic and Clinical Pathology.