The psychosocial impact of prostate cancer screening for BRCA1 and BRCA2 carriers

Abstract

Genetic screening; Prostate cancer; Psychosocial

Cribratge genètic; Càncer de pròstata; Psicosocial

Cribado genético; Cáncer de próstata; Psicosocial

Objectives To report the long-term outcomes from a longitudinal psychosocial study that forms part of the ‘Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted Screening in men at higher genetic risk and controls’ (IMPACT) study. The IMPACT study is a multi-national study of targeted prostate cancer (PrCa) screening in individuals with a known germline pathogenic variant (GPV) in either the BReast CAncer gene 1 (BRCA1) or the BReast CAncer gene 2 (BRCA2). Subjects and Methods Participants enrolled in the IMPACT study were invited to complete a psychosocial questionnaire prior to each annual screening visit for a minimum of 5 years. The questionnaire included questions on sociodemographics and the following measures: Hospital Anxiety and Depression Scale, Impact of Event Scale, 36-item Short-Form Health Survey, Memorial Anxiety Scale for PrCa, Cancer Worry Scale, risk perception and knowledge. Results A total of 760 participants completed questionnaires: 207 participants with GPV in BRCA1, 265 with GPV in BRCA2 and 288 controls (non-carriers from families with a known GPV). We found no evidence of clinically concerning levels of general or cancer-specific distress or poor health-related quality of life in the cohort as a whole. Individuals in the control group had significantly less worry about PrCa compared with the carriers; however, all mean scores were low and within reported general population norms, where available. BRCA2 carriers with previously high prostate-specific antigen (PSA) levels experience a small but significant increase in PrCa anxiety (P = 0.01) and PSA-specific anxiety (P < 0.001). Cancer risk perceptions reflected information provided during genetic counselling and participants had good levels of knowledge, although this declined over time. Conclusion This is the first study to report the longitudinal psychosocial impact of a targeted PrCa screening programme for BRCA1 and BRCA2 carriers. The results reassure that an annual PSA-based screening programme does not have an adverse impact on psychosocial health or health-related quality of life in these higher-risk individuals. These results are important as more PrCa screening is targeted to higher-risk groups.

We thank all of the participants who took part in this research. This research was sponsored by the Institute of Cancer Research, London, UK and is supported by grants from Cancer Research UK (Grant references (C5047/A21332, C5047/A13232 and C5047/A17528)) and the Ronald and Rita McAulay Foundation and the Peacock Charitable Trust. We acknowledge funding from the UK National Institute for Health Research (NIHR) to the Biomedical Research Centre at The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, at Manchester University Foundation Trust (IS-BRC-1215-20007), the Oxford Biomedical Research Centre Programme, and the Cambridge Clinical Research Centre, NIHR Cambridge Biomedical Research Centre (NIHR203312). We thank Mr and Mrs Jack Baker for supporting the study in NorthShore University Health System, Evanston, IL, USA.