Prostate cancer guidelines should be updated so that all men aged 40 and over with BRCA1 or BRCA2 gene mutations are offered regular PSA testing, according to scientists at The Institute of Cancer Research (ICR), London.
Their call follows new results from the international IMPACT study, which found that PSA screening detects more aggressive prostate cancers in men carrying BRCA1 and BRCA2 mutations than in non-carriers.
Routine PSA testing is not currently recommended for the general population, however, the ICR team says that targeted screening for those at higher genetic risk could save lives by identifying dangerous cancers earlier.
Initial IMPACT findings, published in 2019, showed that men with BRCA2 mutations have a significantly higher risk of aggressive prostate cancer and should be offered annual PSA testing — evidence that helped shape European guidelines.
The latest results, presented at the ESMO Congress 2025, now show that men with BRCA1 mutations should also be included. The study found that BRCA1 carriers were three times more likely to develop fast-growing, aggressive prostate cancers compared with non-carriers, though their overall risk of developing prostate cancer and average age at diagnosis did not differ.
For BRCA2 carriers, the risk of prostate cancer was more than doubled — from 1.4% to 3.1% — with diagnosis typically occurring at age 60, five years earlier than for non-carriers.
The IMPACT study, conducted across 65 centres in 20 countries, is funded by Cancer Research UK, Cure BRCA, the NIHR Biomedical Research Centre at The Royal Marsden and the ICR, and the Ronald and Rita McAulay Foundation.
Researchers say that while new genetic tests are in development, targeted PSA screening remains a vital step toward earlier diagnosis for those at highest risk.
