Fear factor: first pre-emptive removal of prostate

Michael Cook
25 May 2013
Reproduced with Permission

Following the highly publicised pre-emptive double mastectomy of Hollywood celebrity Angelina Jolie, it has emerged that a 53-year-old British man has become the first in the world to have a pre-emptive removal of his prostate. He discovered that he had a "faulty" BRCA2 gene which is associated with breast and prostate cancer and asked his surgeon to remove it.

Initially the doctors were reluctant as he appeared to be completely healthy. The operation also entails some risk and has side-effects: infertility and possibly permanent incontinence and sexual dysfunction. However a biopsy did detect some microscopic malignant changes and the doctors went ahead.

The surgeon, Roger Kirby, told the London Sunday Times that even in this case, he would not normally operate.

"But given what we now know about the nature of BRCA2, it was definitely the right thing to do for this patient. A number of these BRCA families have now been identified, and knowing you are a carrier is like having the sword of Damocles hanging over you. You are living in a state of constant fear. I am sure more male BRCA carriers will now follow suit."

Dr Marc Garnick, editor-in-chief of the Harvard Annual Report on Prostate Diseases, agreed that the decision was driven by fear of the BRCA gene. This was based "predominantly on emotions, not data," he told Medscape Medical News. "Medical science is charged with determining if this is ultimately the right thing to do, and only appropriately conducted clinical research can answer this question."