Ask the experts

Who should get genetic testing?

Genetic testing helps doctors learn about a gene(s) and its role in disease. The type of testing done will vary for each person based on health and family history.

These tests look for genetic mutations that were either passed down through your family or acquired. These tests find gene mutations like BRCA1 or BRCA2 that raise a person’s risk of getting prostate and other cancers. If these genes are found in a person without cancer, your doctor may suggest taking steps to prevent cancer. For example, it would be helpful to eat more plant-based and healthy foods, get more exercise and stop using tobacco products to reduce your risk of getting cancer.

For people who already have cancer, genetic tests tell your doctor how aggressive the cancer cells are. These tests are also used to learn which treatments could work best for certain types of cancer.

In other words, some treatments are known to be more helpful in men with advanced prostate cancer and BRCA1 or BRCA2 gene mutations, than in other men. Genetic testing is the first step for precision medicine.

Patients with advanced prostate cancer should think about genetic testing to help with treatment choices. Patients with prostate cancer that has not spread but who have a high Gleason score of 8-10 and/or a family history of breast, ovarian or prostate cancer, should ask about these tests to control cancer. Patients who don’t have cancer, but have a family history, can sometimes get tested to help detect cancer early or prevent cancer. Start by talking with your doctor to find out if this type of testing is right for you.

Dr. Todd Morgan, a urological surgeon and Chief of Urologic Oncology at Michigan Medicine, specializes in helping patients with prostate, bladder, kidney and penile cancers.

What should I do if I want to start a family but there is a family history of cancer?

If you are thinking of starting a family but there is a strong family history of prostate or breast cancer, you may want to talk with your doctor about if genetic counseling is right for you. A genetic counselor will be able to talk with you more about options for having children.

Many cases of prostate cancer and breast cancer are not linked to genetic mutations. But some people have a mutation in genes known as BRCA1 or BRCA2. These mutations raise the risk of getting prostate, breast, ovarian or pancreatic cancer.

If you or your partner decide to get a genetic test and one of you has a mutation, you have many options, which include:

  • Having your children as planned. If you have a BRCA1 or BRCA2 mutation, each child has a 50% chance of also having it. Your children could decide to get tested for the mutation once they are adults.
  • Adoption.
  • Pre-implantation genetic diagnosis. This procedure allows families to avoid passing on an inherited condition to their children. It requires in vitro fertilization (IVF). A woman’s eggs are collected and fertilized with her partner’s sperm in a lab. Cells from the fertilized eggs (embryos) are tested for a gene mutation. If the embryo does not have the mutation, it is transferred to the woman’s womb.
  • Prenatal testing. Early in the pregnancy, the fetus can be tested for inherited genetic mutations.
  • Donor egg or sperm donation. Once the donation is made, IVF is done.

If you or your partner has a genetic mutation, there is no one right answer about whether to start a family. Speaking to a genetic counselor about your options will help you make the best choice for you and your family.

Dr. Daniel Lin, a urologist at University of Washington and Fred Hutchinson Cancer Research Center, focuses on genitourinary oncology, early detection and translational research.

How common is post-prostatectomy incontinence or erectile dysfunction?

It’s an emotional and stressful time for men who go through prostate cancer treatment. On one hand, it’s common to feel relief. On the other, men feel discomfort after surgery and may be anxious about their cancer coming back.

The side effects that are most common after prostatectomy are incontinence (not being able to control your bladder) and erectile dysfunction, or ED (not being able to get a full erection). Two things that are often embarrassing to talk about. These issues could be short-term, long-term or show up months later.

What you should know is there are treatment options for both incontinence and ED. These things are common, but they may not go away without treatment. The best thing you can do is tell your doctor if you are bothered by these side effects.

For incontinence, treatment starts with a disposable pad, then pelvic floor exercises. A specialized Physical Therapist can teach you the correct way to strengthen your pelvic muscles. Some medications help too. Surgery is a last option, where a urologist can implant a device called an artificial urinary sphincter.

For ED, oral medications (like Viagra) are used to improve blood flow to the penis. A penile pump may help if medications don’t. Penile injections can boost blood flow for an erection. Or a penile implant can be surgically placed in the penis to inflate for an erection. This is only used for permanent ED.

It is of great value to talk with your doctor about side effects and concerns. Often, there are things you can do to help.

Dr. Daniel Parker, a urologist at University of Oklahoma, Stephenson Cancer Center, focuses on urologic oncology and urologic cancers including prostate, bladder, penile, kidney and testicular.  |  FALL 2022  |  UROLOGYHEALTH extra