Mix of genes linked to prostate cancer

Scientists have taken a key step toward revealing the causes of prostate cancer, finding that a combination of five gene variants dramatically raises the risk of the disease. Added to family history, they accounted for nearly half of all cases in a study of Swedish men.

The discovery is remarkable not just for the big portion of cases it might explain, but also because this relatively new approach -- looking at combinations rather than single genes -- may help solve the mysteries of many complex diseases like cancer and diabetes that are thought to involve multiple genes or interactions between them.

“It gives us a new way of looking at genetic risk factors,” said Dr. Teri Manolio of the National Human Genome Research Institute, the federal agency focused on such work.

It also might lead to a blood test to predict who is likely to develop prostate cancer. These men could be closely monitored and perhaps offered hormone-blocking drugs like finasteride to try to prevent the disease.

The Swedish results must be verified in other countries and races, where the gene variants, or markers, may not be as common. Researchers already have plans to look for them in U.S. men.

The markers have nothing to do with the aggressiveness of a tumor, only whether a man is likely to develop one, so they do not help doctors tell which cancers need treatment and which do not.

Nor did the markers correlate with levels of PSA, a blood substance often used to gauge cancer risk. PSA is a notoriously imprecise measure, so a gene test that independently predicts risk would be valuable, experts said.

This “eyebrow-raising study” should quickly spur more research, particularly in blacks, who have a higher incidence of prostate cancer, said Dr. Howard Sandler, a cancer specialist at the University of Michigan and spokesman for the American Society of Clinical Oncology.

The study was led by doctors at Wake Forest University in Winston-Salem, N.C., and involved Johns Hopkins University in Baltimore and the Karolinska Institute in Stockholm. Results were published online Wednesday by the New England Journal of Medicine.

Prostate cancer is the most common cancer in American men and arguably the most mysterious.

Unlike breast cancer, where variants in single genes like BRCA are known to confer greater risk, few have been discovered for prostate cancer. In the last year, other researchers identified five, but none individually seemed to raise risk much.

Combinations of them did, the new work reveals.

It involved 2,893 men with prostate cancer and 1,781 similar men who did not have the disease.

Sweden was chosen because the population is so ethnically similar and well suited to gene studies.