Empowering prevention of Prostate Cancer*
The American Urological Association (AUA) recommends that men 40 years of age or older should be offered a risk assessment and early detection for prostate cancer and men who wish to be screened should have both a prostate-specific antigen (PSA) test and a digital rectal exam (DRE). The AUA believes that a risk assessment at the age of 40, including a base line PSA measurement is of value for a more cost effective prostate cancer screening and prevention. Also the AUA is of the opinion that the decision to proceed to prostate biopsy should be based not only on PSA and DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities
(http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/e/early-detection-of-prostate-cancer.cfm
http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf ).
The American Cancer Society recommends that screening should be offered to all men 50 years and older, and as early as age 40 for men with more than 1 risk factor. Screening should include, for those who elect to undergo screening, a yearly digital rectal exam and a prostate specific antigen (PSA) blood-test at the minimum. (http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_prostate_cancer_be_found_early_36.asp?sitearea=)
The deCODEme ProstateCancer™ test results can have a significant effect on men's overall risk for prostate cancer and is an important part of a baseline risk assessment for deciding on the frequency and extent of screening for those men who choose to be regularly screened. Especially deCODEme ProstateCancer™ may be useful for the identification of those who should have a more closer and frequent screening exams, even in the absence of the well known risk factors such as family history or ethnicity. Also deCODEme ProstateCancer™ may be used along with other factors in the decision making on when to proceed to prostate biopsy.
The test identifies three sequence variants on chromosome 8, two on chromosome 17, one on chromosome 2, one on chromosome 11 and one on the X-chromosome that significantly increase the risk of developing prostate cancer. For chromosome 17, the discovery of a sequence variant that accounts for at least part of the inverse relationship between prostate cancer (increased risk) and type 2 diabetes (decreased risk) in individuals of European, African, and Asian descent, provides a step toward understanding the complex biochemical interactions in the genetics of these two diseases, interactions that point to one or more metabolic or hormonal pathways important for the normal functioning of individuals throughout their lives that incidentally modulate the risk of developing prostate cancer and type 2 diabetes late in life. The combined use of all the risk variants used in the deCODEme ProstateCancer™ for risk prediction for individuals of other ethnicity than European wait further evaluation of adequate size cohorts of the respective ethnicities.
Based on the presumption that these markers are independent and their individual risk therefore additive the various genotype combinations have associated relative risks in the range of 0.33(non carriers for any of the risk markers) – 17.6 (homozygous (two-copies) for all of the eight risk variants) over the general population risk. Combined these 8 variants appear to account for about half (50%) of the cases in the population (termed population attributable risk). About 40% of the population has a genotype combination of the tested markers that have an increased relative risk (>1) over the general population and about 10% of the population has a genotype combinations that have an average relative risk of 2.0 and about 1% relative risk above 3. One should be careful to apply extreme risk results to individuals since they are based on presumptions of a multiplicative model and are associated with genotype combinations that are extremely rare. For example, genotype combinations promoting combined relative genetic risk over 5.0 are extremely rare (about 1 in 10,000). For this reason the highest reported combined genetic risk result is limited to 5.0, equivalent to a lifetime risk of 80%.
For a disease such as prostate cancer, for which the exact causes are still unknown, this new knowledge is in itself empowering for the field of genetics and health. For individuals, this knowledge now makes it possible to identify genetic predisposition in advance of the development of the disease, and hence offers the possibility to take action in collaboration with one’s physician to start earlier screening for and identification of, prostate cancer in the earliest stages when there is still an almost 100% success rate of treatment.
Independent of the family history for prostate cancer or other cancers, knowing ones genetic make-up in regard to deCODE’s genetic prostate cancer risk markers is relevant since the markers provide risk beyond the familial risk.
The deCODE ProstateCancer ™ test therefore offers a new factor and added weight to the analysis of an individual’s risk for prostate cancer which may help the individual and his/her physician to decide on future monitoring, prevention and/or specific treatments.
If you have additional questions regarding the deCODE study or the deCODE ProstateCancer™ test, please contact deCODE at diagnostics@decode.com, or by phone at 1-877-222-6510 and a deCODE representative will respond promptly to your questions.
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