Prostate cancer is a type of malignant tumour arising in the prostate gland, which is a small gland in the reproductive system. It tends to develop in men over the age of 50. Prostate cancer tends to develop slowly, but it can be aggressive and metastasise to other parts of the body. AntePC is a unique test for personalised assessment of prostate cancer risk that combines the genetics of polygenic risk scores and monogenic mutations with individual lifestyle risk factors. The test increases men’s awareness of their overall risk of prostate cancer and guides individualised monitoring.
Who can benefit from the AntePC test?
AntePC is suitable for men aged 25–80 who have European ancestry.
How frequent is prostate cancer?
Prostate cancer is the most common cancer among men in the EU. With 376,000 new cases in EU28 in 2018, prostate cancer makes up 13.5% of all new cancer cases and 23% of new cases in men. Particularly prevalent in men over 65, prostate cancer is the third most common cause of cancer deaths among men across EU countries. It resulted in 75,300 deaths in 2015 – more than 10% of all male cancer deaths.
The genetics behind prostate cancer
The heritability of prostate cancer has been estimated to be around 57%. Men carrying specific deleterious mutations in the genes HOXB13, BRCA2 and BRCA1 have a markedly higher risk of developing prostate cancer. They also have an elevated risk of developing aggressive forms of prostate cancer. Mutations of other genes, which affect the risk of prostate cancer, include ATM, CHEK2, MSH1, MLH1, MSH2, MSH6, PALB2 and RAD51D.
Prostate cancer also has a polygenic susceptibility component. Large-scale genome-wide association studies (GWAS) have led to the discovery of hundreds of single nucleotide polymorphisms (SNPs) associated with prostate cancer risk that explain around 30% of prostate cancer cases. Currently, around 40 published GWAS on prostate cancer provide a foundation for the development of polygenic risk scores.
Prostate cancer risk factors
The primary known risk factors of prostate cancer are:
- Age – the risk of developing prostate cancer rises rapidly after the age of 50 and significantly escalates in men older than 65
- Family History – first-degree relatives of men with prostate cancer have approximately twice the risk of developing prostate cancer compared with the general population
- Genetic predisposition – changes in specific genes carried in families; high-risk SNPs
- Ethnicity – African Americans are in a higher risk category
- Obesity – prostate cancer is characterised in part by dysregulated lipid metabolism
- Alcohol and meat consumption
Early detection and screening of prostate cancer
There are several methods of prostate cancer detection: measurement of the prostate-specific antigen (PSA) level, digital rectal examination of the prostate gland, prostate volume measurement, transrectal ultrasonography and prostate biopsy.
Routine, widespread prostate cancer screening programmes are currently not recommended because false positives and overtreatment outweigh the benefits. This situation is complicated by the fact that prostate cancer is relatively common. Even though most prostate cancer diagnoses have a good prognosis, it remains the second highest cause of cancer death in men, and can often progressively evolve to require more aggressive treatment. With no current population screening programmes in place, genetics-based screening presents a unique opportunity for the risk stratification of men and targeted screening for those most at risk.
AntePC will be available in the second half of 2019.