BRCA FAQ’s

There is a huge amount of uncertainty related to a positive BRCA1 and BRCA2 gene diagnosis. During our 2020 BRCA webinar, you submitted some of your questions and our panel of experts have answered them.

General FAQ’s:

Q1: What is the difference between BRCA1 and BRCA2?

BRCA1 and BRCA2 are tumour suppressor genes. The two genes work together in a pathway that works to protect our DNA from damage. Faults (or mutations) in either gene are known to cause an increased risk of developing certain cancers. In women, they predominantly cause and increased risk of breast and ovarian cancer. In men, faults in these genes can cause an increased risk of prostate and breast cancer.

The slight difference between the two genes is found in the cancer risks associated with each gene. It can be difficult to get accurate information regarding the risk associated with these genes as the risks vary in different studies and also vary over time. As Dr McVeigh mentioned, there are many variables that add together to define an individual’s cancer risks. We are getting better at giving more individualised risk assessments based on both genetic and environmental/lifestyle factors.

BRCA1 is associated with a slightly higher lifetime risk of developing breast cancer than BRCA2. However, this difference in risk is negligible. Women with a BRCA1 mutation are thought to have a 72% risk of developing breast cancer by the age of 80. Women with a BRCA2 mutation are thought to have a 69% risk of developing breast cancer by the age of 80.

Women with a BRCA1 mutation are thought to have a higher risk of developing ovarian cancer compared to women with a BRCA2 mutation. Women with a BRCA1 mutation are thought to have a 44% risk of developing ovarian cancer by the age of 80. Women with a BRCA2 mutation are thought to have a 17% risk of developing ovarian cancer by the age of 80. This risk of developing ovarian cancer starts to increase from a woman’s later 30s. It appears that the risk of ovarian cancer for women with BRAC2 starts to rise for a woman’s mid-40s. Therefore, women may be given slightly different advice about when to consider risk-reducing Bilateral Salphingo-oophorectomy (rrBSO) depending on their mutation and also based on their family history.

These figures are based on a prospective study which followed almost 10,000 women with either a BRCA1 or BRCA2 mutation: Kuchenbaecker, Karoline B., et al. “Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers.” Jama 317.23 (2017): 2402-2416.

Men with a BRCA2 mutation are thought to have a 25% lifetime risk of developing prostate cancer (compared with a ~12% risk in the general population). They may also be at risk of developing prostate cancer at earlier ages and there is some evidence that their prostate tumours may be more aggressive. There is no clear evidence that men with a BRCA1 mutation are at an increased risk of prostate cancer.

Men with a BRCA2 mutation have a slightly higher risk of developing male breast cancer compared with men with a BRCA1 mutation. The life time risk of developing male breast cancer is still thought to be low.

There is some evidence that the risk of developing pancreatic cancer is slightly increased in families with a BRAC2 mutations. Please see Dr McVeigh’s answer to Q.10 regarding pancreatic cancer risk.

Q2: Why is the risk higher with BRCA1?

Data collected over time following families with BRCA mutations show a slightly higher incidence of breast cancer and a higher incidence of ovarian cancer in women with a BRCA1 mutation when compared to women with a BRCA2 mutation. Studies also show a higher incidence of prostate cancer in men with a BRAC2 mutation compared to men with a BRCA1 mutation. Please see the discussion above. It is not clear what causes the differences in these risks.

Q3: At what age should I have children tested for the BRCA?

As BRCA gene alterations are not usually associated with cancer risk in childhood or teenage years, genetic testing is not usually undertaken until individuals are able to give informed consent as adults.

Q4: Is skin cancer related to the BRCA gene?

Melanoma has also been noted to occur with increased frequency in individuals with BRCA gene alterations (BRCA2 more so than BRCA1), but the absolute risk is quite low, and modified by other factors such as skin type (fair or sallow) and environmental exposure (sunlight).

To minimise the risk of melanoma, we recommend avoiding sunburn and wearing high factor sun cream. Individuals that avoid the sun run the risk of vitamin D deficiency, as sunlight is our main source of this vitamin. There are dietary sources of vitamin D, including oily fish and egg yolks, and supplementation if required.

Q5: How do I get referred for genetic testing and how long will I have to wait for my results?

Getting referred

If you wish to access genetic testing through the public service, you can request a referral from your GP, or for patients undergoing cancer care from your Oncologist/Surgeon involved in your care. Referrals can be sent to the Cancer Genetics Service in St James’s Hospital or The Department of Clinical Genetics in Children’s Health Ireland at Crumlin.

If a gene alteration is already known in your family, it can be helpful for your doctor to include the details of family members who have already undergone testing in the referral letter, or the family reference number (pedigree number) if known.

For individuals with a personal history of cancer who want to know if they are eligible for genetic testing, it can be helpful to include a completed family history form with your referral letter. Forms can be obtained from the websites of the service you are being referred to.

Timing of results

  • For a predictive test (testing for a gene alteration already known in your family):

Once you have attended your appointment and had a blood sample taken, the results take approximately 3-4 months.

  • For a diagnostic test (if you have a personal history of cancer and are undergoing genetic testing to try find if your cancer is due to a gene alteration):

Once you have attended your appointment and had a blood sample taken, the results take up to 6 months. If results are required on an urgent basis for planning your cancer treatment, your referrer should include this information in the referral letter.

Timelines can vary and you can seek individualised information from your service when you attend for your testing appointment.

 

Q6: I heard other countries use the Roma Index for CA125 for screening. Would Ireland do the same?

 

Q7: What age can a woman be referred publicly in Ireland for genetic testing for mutations of the BRCA gene?

The cancer risks associated with BRCA gene mutations are adult-onset. Therefore, adults can request a referral from their GP if they wish to undergo genetic counselling and decide when is the right time for them to have testing.

Q8: 60% in Beaumont have had prophylactic surgery. How many of these had cancer? And how many have surgery to reduce risk but didn’t have cancer?

 

Q9: Is use of prophylactic antibiotics advocated in TRSU biopsy to reduce infection risk? 

 

Q10: Is there anything we should be doing in line with pancreatic cancer? Assume you can’t screen and just need an awareness of some symptoms.

Unfortunately, there is no proven screening for Pancreatic Cancer. Research is on-going to determine if and what type of screening is effective in families at high risk of Pancreatic cancer, as part of the EUROPAC study  This study will include patients with BRCA alterations over the age of 40 if they have two or more affected close relatives. At the present time, we do not recommend routine screening for Pancreatic Cancer in families with BRCA gene alterations outside of a research study.  We recommend people avoid smoking, as this can increase the risk of pancreatic cancer

Q11: Can we have copies of the slides for future reference?

Our full BRCA 2020 Webinar is available to view here.

 

breastBRCA and breast cancer:

Q12: I have BRCA1 and had breast cancer. My doctor has said that since I have had a complete hysterectomy, my risk of future cancer is reduced by 50%, but Terri mentioned that this is only relevant for BRCA2. What is the research on this and is there any papers I can read?

I can’t speak about this lady’s personal risk as she hasn’t provided any information about her previous cancer or age.

I presume this question relates to the impact of oophorectomy (ovarian removal) rather than hysterectomy (womb removal).

For BRCA carriers that have had their ovaries removed (oophorectomy), the risk of ovarian cancer is reduced by 96%. There have been rare instances where ovaries have been removed and ovarian-like cancer has subsequently developed in the cells lining the abdomen (called the peritoneum) since these are from the same origin as those cells covering the surface of the ovary. The risk of this occurring is not known precisely, but is thought to be quite low (about 2% – 3%).

For a long time, it was believed that risk-reducing ovarian surgery reduced the risk of breast cancer in carriers of BRCA1/BRCA2 gene alterations if undertaken prior to the natural menopause – recent data suggests this effect is limited to BRCA2 gene carriers only. One recent paper is Mavaddat N, Antoniou AC, Mooij TM, et al. Risk-reducing salpingo-oophorectomy, natural menopause, and breast cancer risk: an international prospective cohort of BRCA1 and BRCA2 mutation carriers, but please be advised that this is meant for a medical reader.

Q13: Is it recommended to have risk-reducing breast surgery for someone who has ovarian cancer (BRCA1 in my late 60’s)

Q14: I have just recovered from Triple Negative Breast Cancer at the age of 37. I have had a double mastectomy. As I am BRCA2, does this increase my recurrence rate? 

Q15: Do you recommend keeping or removing nipples?

 

BRCA and ovarian cancer:

Q16: I am 57, BRCA1, had TNBC and also had preventative oophorectomy surgery which showed sections from the fallopian tubes with P53 staining and thankfully caught in time. My question is are BRCA1 still at risk of other types of cancer after this surgery, eg. Uterine cancer, and would a full hysterectomy be recommended?

There have been rare instances where ovaries have been removed and ovarian-like cancer has subsequently developed in the cells lining the abdomen (called the peritoneum) since these are from the same origin as those cells covering the surface of the ovary. The risk of this occurring is not known precisely, but is thought to be quite low (about 2% – 3%).

The risk of cancer of the womb in BRCA carriers is thought to be equivalent to the risk of the general population, and hysterectomy is not recommended based on our current guidelines.

Q17: It says there is an increased risk of heart disease, dementia and osteoporosis after ovaries being removed. What is the level/rate of this risk?

Osteoporosis is a disease characterized by low bone mineral density (BMD ) and, worldwide, is responsible for more than nine million fractures each year and associated with increased mortality. The rate of bone loss among untreated post-menopausal women causes a doubling in the risk of fracture every 10 years, on average. In addition, age-related factors other than bone loss also contribute, causing fracture risk to double approximately every 5 years overall. Thus, among women who experience surgically-induced menopause, post-oophorectomy, the risk is significantly increased for osteoporosis, fracture, as well as for subsequent morbidity and mortality.

Oophorectomy increases the risk of osteoporosis and cardiovascular disease. Women who are more than 10 years post menopause and who have had their ovaries removed lose bone mineral density (BMD) at twice the rate of those who have kept their ovaries and show greater progression in the thickening of the carotid artery.

Q18: Does your family history indicate your increased risk of one of the different cancers? Ie. if only breast cancer is in your family and you are a known BRCA2 carrier, does that indicate that breast cancer is the predominant risk in your family? And that your ovarian cancer risk may be less than that reported in general with BRCA2?

We are gathering more information about how the differences in family history, lifestyle factors and hormonal factors can be added to an individual’s genetic test result in order to make a more individualised cancer risk assessment. Although family history can influence risk, women with a BRCA1 or BRCA2 mutation are at a significantly higher risk of developing ovarian cancer, even if there are no known cases of ovarian cancer in the family. In the same way, a woman with a BRCA1 or BRCA2 mutation are at a significantly higher risk of developing breast cancer, even if there are no known cases of breast cancer in the family.

Q19: Does removing the fallopian tubes instead of the ovaries work as a risk-reducing surgery option for women testing positive for mutations of the BRCA gene?

At present, the only proven way for women at high risk to manage ovarian risk is to consider preventative surgery (removal of the ovaries and fallopian tubes, known as a Risk-Reducing Bilateral Salpingo-Oophorectomy, RR-BSO), usually after age 40. This obviously has significant impacts, with immediate infertility and premature menopause.

The PROTECTOR study (PReventing Ovarian cancer Through Early Excision of Tubes and Late Ovarian Removal) is underway across centres in the UK, to determine if risk-reducing surgery could be undertaken in two stages –

  1. First stage: Early Removal (prior to menopause, but after the age of 30y) of the fallopian tubes (Risk-Reducing Early Salpingectomy, RRES)
  2. Second Stage: Removal of the ovaries at a later date, closer to the menopause (Delayed Oophorectomy, DO).

By deferring oophorectomy to a later age, the risks associated with a premature menopause could be minimised. It is important to determine to what degree cancer risk is minimised by this approach compared to standard practice. At present, we only generally recommend this two stage approach within the context of a research study.

Further information about PROTECTOR is available here

Q20: I am a 34 year old BRCA1 carrier and had a bilateral prophylactic mastectomy when I was 29. I am family complete and would like to know what age is recommended for prophylactic oophorectomy?

Women who undergo RR-BSO before their natural menopause are at risk of side effects related to premature menopause. Menopausal symptoms can vary greatly from one individual to another. Some women may have no menopausal symptoms after surgery; others may have some, such as hot flushes, night sweats, tiredness, loss of libido, vaginal dryness and mood changes. Women who experience premature menopause also have increased risks related to bone, heart or brain health. Because of these risks, we do not recommend RR-BSO before the age of 35, and usually closer to 40 years of age.

Women who have a Risk-reducing Bilateral Salpingo-Oophorectomy (RR-BSO) before 50 are usually offered Hormone Replacement Therapy to prevent significant menopausal symptoms and to protect their general well-being (including heart and bone health). We recommend that, after RR-BSO, women (who have not had Estrogen-Receptor-Positive breast cancer) have HRT up until age 50 to 51, as this is the usual age at which menopause would have otherwise occurred naturally. Studies show that women who have had RR-BSO before age 50 actually have less breast risk (despite taking HRT) than women who still have ovaries.

 

 

HRT and menopause:

Q21: What would the recommended HRT be post prophylactic total hysterectomy?

Depending on risk factors (smoking/ obesity/ no exercise), I would recommend Fematab 2mg for those slim, non -smoking women who exercise and have no history of clots. It’s the cheapest option at €10/month and compliance is good. Oestrogen ONLY for women post-hysterectomy.

For others who prefer patch or gel- the gel is transdermal meaning no risk of clots and applied daily so again compliance should be good (Divigel /Oestrogel / Oestrodose)

Patches are also transdermal but the shortage is a problem and sometimes compliance as they have to be changed every 72 hours (Estradot 50mcg/ Evorel 50mcg)

Testosterone will also be needed for those women post total hysterectomy- either sachet or gel pump (Testogel / Androfeme)

Q22: There seems to be a serious shortage of HRT patches at the moment. Why is this so and is it likely to be rectified soon?

The shortage of patches is a Pharma issue where companies are merging and rebranding- out of our control unfortunately so we will find an alternate treatment while waiting on them

Q23: I have the BRCA1 gene and have had the oophorectomy and mastectomy and reconstruction in the last 14 months. I am on HRT. I know there are mixed opinions on HRT – I had the ovaries and tubes removed first and that took a few months to recover from before I could think about the overwhelming option of a mastectomy due to menopause. Would welcome thoughts on this and whether this could be dealt with differently and if there was more material available to patients at the consultation phase and referred on to relevant specialists that can help.

Women who have a Risk-reducing Bilateral Salpingo-Oophorectomy (RR-BSO) before 50 are usually offered Hormone Replacement Therapy to prevent significant menopausal symptoms and to protect their general well-being (including heart and bone health). We recommend that, after RR-BSO, women (who have not had Estrogen-Receptor-Positive breast cancer) have HRT up until age 50 to 51, as this is the usual age at which menopause would have otherwise occurred naturally.

The decision about whether or not to have a risk-reducing mastectomy is very personal, and the survival difference between women undergoing surgery compared to surveillance is small – and this difference gets even less with increasing age – so a lot of patients never have risk-reducing breast surgery, but we still recommend they do have HRT after risk-reducing ovarian surgery if they were pre-menopausal at the time of their operation.

Studies show that women who have had RR-BSO before age 50 actually have less breast risk (despite taking HRT) than women who still have ovaries.

Q24: There has been a lot of media in recent months about the associated risk of HRT and the development of breast cancer. Is there a safe for of HRT?

Combined HRT (Oestrogen & Progesterone) carries an increased risk by an additional 4 women > 50 years/1000 women over 5 years but the risk is the same as the oral contraceptive pill or smoking. Exercise and reduced alcohol with weight reduction reduces that risk. Oestrogen only (for women who have had a hysterectomy) reduces risk of breast cancer. The safest form is gel or patch as both transdermal and do not go through the liver

Q25:  I had chemo for breast cancer nearly four years ago and have been experiencing intermittent menstrual cycles and menopause since. I have all the menopausal symptoms mentioned by Dr Forde. I’ve had triple-negative BC but BRCA negative. Sleeping is impossible. What options are available for me? I’m 35 now.

No contra-indication to HRT so will need sequential HRT (Oestrogen & Progesterone) – 2 weeks oestrogen  / 2 weeks oestrogen & progesterone ..will then have a bleed. Need to keep to this regime up to age of 50. Products are Femostan 2/10 (oral) or combination of gels/ patches or capsules (Utrogestan)

Q26: I’m 44 and have BRCA1. I had triple-negative cancer and have had a DMX with no reconstruction and my ovaries/fallopian tubes removed. I take venlafaxine to help with the symptoms of menopause, but my libido is greatly affected. Is there anything I can take/do to improve this?

You would need combined HRT (Oestrogen & Progesterone) initially and add in Testosterone after 3 months if libido hasn’t improved

Q27: I am a BRCA carrier and have had an oophorectomy in 2017. I previously had estrogen-positive breast cancer, can Dr Forde give me any advice on what I can take during menopause that will help me with the symptoms?

As you had oestrogen positive breast cancer, you are not a candidate for HRT. If you have anxiety, your GP can prescribe Venlafaxine or Escitalopram initially.

Also Sage tablets/ Evening Primrose Oil.  DO NOT TAKE OVER THE COUNTER MENOPAUSE PRODUCTS as they contain SOYA which is a weak oestrogen

 

Questions on treatment options and support services:

Q28: Are there any hospital-based psychology services? I was referred to St. James psycho-oncology team by my breast consultant as I was struggling to come to terms with my diagnosis and they told me that they couldn’t do anything for me. What other services are out there for me?

Some cancer centres have Psych-Oncology services which may offer patients appointments around their diagnosis, or prior to planning risk reducing surgery. Your Genetic Counsellor can review what supports are available to you locally, depending on where you underwent testing.  Other organisations which may have relevant supports include ARC House and Gary Kelly Cancer Support Centres. You can also speak with your GP to clarify if you are eligible for short term support as part of the Counselling in Primary Care initiative.

Q29: I had estrogen-positive breast cancer in 2010 (aged 39). Full hysterectomy in 2011 (aged 40) to reduce my risk from other cancer. I am now 49 years of age, can I use HRT? I attended a genealogical consultant last summer and asked the same question and he was adamant in saying no. It does impact on your quality of life as a woman and I was fully aware of how much the hysterectomy affected mine physically. I am taking tamoxifen for nine years now, any advice would be helpful.

Absolute contra-indication. Use Venlafaxine or Escitalopram for anxiety.

Q30: Is it likely that they will be able to “switch off” the fault in the gene in the future and if so, when do you think this might be trialled?

 

Q31: Would welcome support group options for all after surgeries as well, it can feel a very lonely place both before surgeries and after them.

I agree it can be a very lonely, anxious and stressful time. You can never fully prepare yourself for it emotionally. Though it may feel daunting and a little defeatist, I would recommend accepting support from psychological services provided by your hospital, if any are available.  It will give you some of the tools you might need to get you through this period. One of the issues I and my fellow peer support colleagues would advocate for is better psychological supports for women and men who are BRCA alteration carriers.  Finally, reach out and talk to those who have gone through the experience. You can choose to do this anonymously if you want to. Don’t forget the BRCA peer supporters are here to lend a listening ear for exactly this reason.

Q32: I have just completed treatment (bilateral mastectomies, chemotherapy and radiotherapy) for TNBC and am BRCA1. Are there any drugs or other treatments I could use to reduce recurrence risk?

 

Q33: Is it possible to self-refer to the family genetic clinic in Beaumont? I had breast cancer – chemotherapy, radiotherapy, reconstruction and oophorectomy in 2011 and am BRCA1 but have had no follow up at all from the family genetics point of view. Just the option to contact my breast surgeon on an ad hoc basis if I have any concerns.

 

Q34: I am 47 with BRCA2 and breast cancer in my family. It was recommended to get my ovaries removed. I’m in the middle of a weight loss programme and have one year left as I am very obese. I am afraid I will gain weight due to menopause and am considering waiting for the operation for one year. How do I weigh the benefit and the risks?

If you have finished your family would you consider hysterectomy also as your treatment would be Oestrogen only which reduces risk of breast cancer? Use either gel or patch. Yes wait the year if you can.

Q35: I was diagnosed with BRCA2 diagnosis last November. After seeing the genetic counsellor, gynae and breast specialist, I have received three different options on what I should do. Especially about the timing of when to remove my ovaries and whether I should receive HRT treatment or not. I have my operation scheduled soon, but the insecurity of how my menopause will be treated is putting me off. What do you advise on how I should move forward?

I assume this lady hasn’t had cancer as she hasn’t mentioned it.

Unfortunately, there is no proven form of ovarian cancer screening. A large study called UKFOCSS looked at whether ultrasound and CA125 tumour marker measurement would detect ovarian cancer sufficiently early and reliably for these tests to be introduced as routine screening. This and other studies suggested that screening would not necessarily pick up ovarian cancer early enough for treatment to be effective in curing the cancer. Harm can be done when screening gives false-positive results, causing unnecessary anxiety and investigations. At present, the only proven way for women at high risk to manage ovarian risk is to consider preventative surgery (removal of the ovaries and fallopian tubes, known as a Risk-Reducing Bilateral Salpingo-Oophorectomy, RR-BSO), usually after age 40.

Risk-Reducing Bilateral Salpingo-Oophorectomy (RR-BSO) involves removal of both ovaries and fallopian tubes to minimize cancer risk. This may be done by keyhole surgery and does not usually involve removal of the womb (hysterectomy). There have been rare instances where ovaries have been removed and ovarian-like cancer has subsequently developed in the cells lining the abdomen (called the peritoneum) since these are from the same origin as those cells covering the surface of the ovary. The risk of this occurring is not known precisely but is thought to be quite low (about 2% – 3%).

Women who undergo RR-BSO before their natural menopause is at risk of side effects related to premature menopause. Menopausal symptoms can vary greatly from one individual to another. Some women may have no menopausal symptoms after surgery; others may have some, such as hot flushes, night sweats, tiredness, loss of libido, vaginal dryness and mood changes. Women who experience premature menopause also have increased risks related to bone, heart or brain health. Because of these risks, we do not recommend RR-BSO before the age of 35, and usually closer to 40 years of age.

Women who have a Risk-reducing Bilateral Salpingo-Oophorectomy (RR-BSO) before 50 are usually offered Hormone Replacement Therapy to prevent significant menopausal symptoms and to protect their general well-being (including heart and bone health). We recommend that, after RR-BSO, women (who have not had Estrogen-Receptor-Positive breast cancer) have HRT up until age 50 to 51, as this is the usual age at which menopause would have otherwise occurred naturally. Studies show that women who have had RR-BSO before age 50 actually have less breast risk (despite taking HRT) than women who still have ovaries.

 

BRCA in Men:

Q36: Following prostate robotic surgery, what is the ideal follow up for men with regard to ongoing screening? If a bone scan has not been recommended following Grade 3 cancer, should the patient request this from their GP or consultant? Can there be circumstances where cancer has penetrated beyond the prostate and is treated before surgery? And if so, is this considered a further indicator for a bone scan?

After Robotic Prostatectomy, I would recommend a PSA blood test every 6 months and consultation with a Urologist. PSA   is an excellent marker of any recurrence of disease (which by the way can be treated very successfully with additional radiotherapy or a number of different drugs if required after discussion with your Urologist)

I would not do a bone scan unless the PSA increased to above 20ng/ml that is the current recommendation as the chances of a Bone Scan being positive below this level are extremely small.

Q37: What age would you recommend a PSA testing when there is a history of prostate cancer in the family (brother and or father, and breast cancer also)

With this history I would recommend a digital rectal examination (DRE) and a PSA at age 40. Without any family history it could be at 50, but if concerned a consultation with a GP,and a  DRE and PSA can be arranged. No PSA without a DRE below 40

Q38: As a BRCA2 carrier, my risk of ovarian cancer is less than that of my 65 year old father with prostate cancer. Why is it that males are discharged to their GP and then have to go through the private system, and yet I am offered public appointments. Should BRCA2 males not be continued to be seen in the family risk clinic at a certain age? He currently has a high PSA and is being referred privately for an MRI etc. Surely this isn’t right?

All men in Ireland between 40 and 70 can be referred via their GP to a Rapid Access Prostate Cancer service in 8 designated HSE centres throughout the country run in conjunction with NCCP whether they are BRCA2 negative or positive. The referral is based upon their age-related PSA value and Digital Rectal Exam and they are triaged according to that value.

If you are unfortunate to have a BRCA 2 positive chromosomal alteration and have a normal PSA and Digital Rectal Examination for your age, you are not at an increased risk of prostate cancer as far as we can tell at this point in time. As extra reassurance, some people request a private consultation and an MRI however in keeping with the result of the IMPACT study if your PSA and Digital Rectal Examination are normal for your age then you should not necessarily need an MRI scan.

This is why an MRI is not ordered on the basis of BRCA 2 alone, it must be arranged in conjunction with a PSA and a DRE. However, a private consultation is between a patient and the Urologist whom they choose to attend and as stated may be arranged for added reassurance. If his PSA is elevated for his age an MRI may be beneficial prior to a biopsy but if he had an elevated PSA he could also have been seen in a Rapid Access Prostate Clinic in HSE via his GP unless he requested private consultation.

Q39: Just to highlight the need for psychological support pre-op and in post op for men undergoing decisions following diagnosis?

Thank you for highlighting this issue, through the National Rapid Access Prostate  Clinics psychological support is offered via NCCP funded specialist cancer nurses, Marie Keating also offer a range of psychological supports to men with prostate cancer with literature, telephone support and on their website which is extremely useful and valuable. Locally some regions are better served than others with initiative’s such as Cancer Care West etc. that allow group meetings with survivors and those patients currently undergoing treatment in supervised meetings. However ongoing revenue and commitment is required to keep these services running.

 

 

We would like to say a massive thank you to specialists Dr. Reem Salman, Breast Surgeon, Dr. Terri McVeigh, Mr. Killian Walsh, Consultant Urologist, Dr. Deirdre Forde, Peer to Peer supporter Abi Jackson and genetic counsellors Eoin Hanney and Claire Giffney for not only presenting our first ever BRCA webinar, but for their help in answering the above questions.