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  • Test code: 01362
  • Turnaround time:
    10–21 calendar days (14 days on average)
  • Preferred specimen:
    3mL whole blood in a purple-top tube
  • Alternate specimens:
    DNA or saliva/assisted saliva
  • Sample requirements
  • Request a sample kit
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Invitae Prostate Cancer Panel

Test description

The Invitae Prostate Cancer Panel analyzes genes associated with a hereditary predisposition to prostate cancer. These genes were selected based on the available evidence to date to provide Invitae’s most comprehensive test for hereditary prostate cancer.

The primary panel includes 12 genes associated with prostate cancer. In addition to the primary panel, clinicians can also choose to include 7 genes that have preliminary evidence of an association with this cancer type. At this time, the association of these genes with prostate cancer remains uncertain; however, some clinicians may wish to include genes that may prove to be clinically significant in the future. These genes can be added at no additional charge.

Genetic testing may confirm a clinical diagnosis and guide treatment and management decisions. At-risk relatives may also be identified, allowing pursuit of a diagnostic evaluation, early detection and improved clinical outcome. This test is specifically designed for heritable germline mutations and is not appropriate for the detection of somatic mutations in tumor tissue.

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Primary panel (12 genes)

ATM BRCA1 BRCA2 CHEK2 EPCAM HOXB13 MLH1 MSH2 MSH6 NBN PMS2 TP53

Add-on Preliminary-evidence Genes for Prostate Cancer (7 genes)

Genes with preliminary evidence of association with hereditary prostate cancer are available to add on to the primary panel. Adding on preliminary-evidence genes can increase the number of variants of uncertain significance that are identified. Some clinicians may wish to include genes which do not currently have a definitive clinical association, but which may prove to be clinically significant in the future. These genes can be added at no additional charge. Visit our Preliminary-evidence genes page to learn more.

ATR BRIP1 FANCA GEN1 PALB2 RAD51C RAD51D

  • Hereditary breast and ovarian cancer syndrome (HBOC)
  • Li-Fraumeni syndrome (LFS)
  • Lynch syndrome – also known as hereditary non-polyposis colorectal cancer (HNPCC)

Prostate cancer is the fifth-most-common malignancy in the world. A man’s lifetime risk for developing this type of cancer is 1 in 7 (15%). More than 60% of cases are diagnosed after age 65; it is rarely found in individuals under 40.

Prostate cancer is currently considered to be a complex, multifactorial disease with the vast majority of familial clustering attributed to the interaction of multiple shared susceptibility genes and environmental factors.

Inherited pathogenic variants in certain genes—particularly ATM, BRCA1, BRCA2, CHEK2, EPCAM, HOXB13, MLH1, MSH2, MSH6, NBN, PMS2 and TP53—account for some cases of hereditary prostate cancer. Men with pathogenic variants in these genes have an increased risk of developing prostate cancer and, in some cases, other cancers as well.

Individuals with a pathogenic variant in one of these genes have an increased risk of malignancy compared to the average person, but not everyone with such a variant will actually develop cancer. Further, the same variant may manifest with different symptoms, even among family members. Because we cannot predict which cancers may develop, additional medical management strategies focused on cancer prevention and early detection may be beneficial.

For gene-associated cancer risks, download our Cancer risk poster.

The genes on this panel confer an increased risk of developing prostate cancer in an autosomal dominant inheritance pattern. Several also have autosomal recessive inheritance, or result in clinically distinct autosomal recessive conditions, as outlined below:

  • BRCA2 is associated with Fanconi anemia
  • MLH1, MSH2, PMS2 and MSH6 are associated with constitutional mismatch repair deficiency (CMMR-D)
  • ATM is associated with ataxia telangiectasia (A-T)
  • NBN is associated with Nijmegen breakage syndrome (NBS)

This panel may be considered for individuals with prostate cancer. Other candidates for testing include those whose history is suggestive of a hereditary cancer syndrome, such as a personal and/or family history of:

  • prostate, breast, ovarian, uterine, colon, pancreatic, melanoma, or sarcoma, particularly if early onset (≤50)
  • prostate cancer with a Gleason score ≥7
  • metastatic or high to very high risk localized prostate cancer
  • male breast cancer
  • breast or ovarian cancer and Ashkenazi Jewish ancestry
  • tumor testing shows mismatch repair deficiency (dMMR, e.g., MSI, IHC) or known variant in a cancer susceptibility gene

There are also some common, general features suggestive of a hereditary cancer syndrome family. These include:

  • cancer diagnosed at an unusually young age
  • different types of cancer that have occurred independently in the same person
  • cancer that has developed in both organs of a set of paired organs (e.g., both kidneys; both breasts)
  • several close blood relatives that have the same type of cancer
  • unusual cases of a specific cancer type (e.g., breast cancer in a man)

  1. Cybulski, C, et al. CHEK2 is a multiorgan cancer susceptibility gene. Am. J. Hum. Genet. 2004; 75(6):1131-5. PMID: 15492928
  2. MacInnis, RJ, et al. Population-based estimate of prostate cancer risk for carriers of the HOXB13 missense mutation G84E. PLoS ONE. 2013; 8(2):e54727. PMID: 23457453
  3. Raymond, VM, et al. Elevated risk of prostate cancer among men with Lynch syndrome. J. Clin. Oncol. 2013; 31(14):1713-8. PMID: 23530095
  4. Li, D, et al. The role of BRCA1 and BRCA2 in prostate cancer. Front Biosci (Landmark Ed). 2013; 18:1445-59. PMID: 23747895
  5. Hale, V, et al. CHEK2 (∗) 1100delC Mutation and Risk of Prostate Cancer. Prostate Cancer. 2014; 2014:294575. PMID: 25431674
  6. Pritchard, CC. et al. Inherited DNA-Repair Gene Mutations in Men with Metastatic Prostate Cancer. NEJM, 2016 PMID: 27433846
  7. Beltran, H, et al. Whole-Exome Sequencing of Metastatic Cancer and Biomarkers of Treatment Response. JAMA Oncol. 2015; 1(4):466-74. PMID: 26181256
  8. Hayano, T, et al. Germline Variants of Prostate Cancer in Japanese Families. PLoS ONE. 2016; 11(10):e0164233. PMID: 27701467
  9. Wilkes, DC, et al. A germline FANCA alteration that is associated with increased sensitivity to DNA damaging agents. Cold Spring Harb Mol Case Stud. 2017; 3(5):None. PMID: 28864460
  10. Breast, Cancer, Linkage, Consortium. Cancer risks in BRCA2 mutation carriers. J. Natl. Cancer Inst. 1999; 91(15):1310-6. doi: 10.1093/jnci/91.15.1310. PMID: 10433620
  11. Cybulski, C, et al. NBS1 is a prostate cancer susceptibility gene. Cancer Res. 2004; 64(4):1215-9. doi: 10.1158/0008-5472.can-03-2502. PMID: 14973119
  12. Antoniou, AC, et al. Breast-cancer risk in families with mutations in PALB2. N. Engl. J. Med. 2014; 371(6):497-506. doi: 10.1056/NEJMoa1400382. PMID: 25099575
  13. Pelttari, LM, et al. A Finnish founder mutation in RAD51D: analysis in breast, ovarian, prostate, and colorectal cancer. J. Med. Genet. 2012; 49(7):429-32. PMID: 22652533
  14. Steffen, J, et al. Increased cancer risk of heterozygotes with NBS1 germline mutations in Poland. Int. J. Cancer. 2004; 111(1):67-71. doi: 10.1002/ijc.20239. PMID: 15185344
  15. National Library of Medicine Genetics Home Reference. Prostate cancer. Accessed January 2018.
  16. Tischkowitz, M, et al. Analysis of the gene coding for the BRCA2-interacting protein PALB2 in hereditary prostate cancer. Prostate. 2008; 68(6):675-8. PMID: 18288683
  17. Pakkanen, S, et al. PALB2 variants in hereditary and unselected Finnish prostate cancer cases. J Negat Results Biomed. 2009; 8:12. PMID: 20003494
  18. Erkko, H, et al. A recurrent mutation in PALB2 in Finnish cancer families. Nature. 2007; 446(7133):316-9. PMID: 17287723
  19. Moran, A, et al. Risk of cancer other than breast or ovarian in individuals with BRCA1 and BRCA2 mutations. Fam. Cancer. 2012; 11(2):235-42. PMID: 22187320
  20. Huang, H, Cai, B. G84E mutation in HOXB13 is firmly associated with prostate cancer risk: a meta-analysis. Tumour Biol. 2014; 35(2):1177-82. PMID: 24026887
  21. Hoffmann, TJ, et al. Imputation of the rare HOXB13 G84E mutation and cancer risk in a large population-based cohort. PLoS Genet. 2015; 11(1):e1004930. PMID: 25629170
  22. Schneider, K, et al. Li-Fraumeni Syndrome. 1999 Jan 19. In: Pagon, RA, et al, editors. GeneReviews (Internet). University of Washington, Seattle. PMID: 20301488
  23. Beebe-Dimmer, JL, et al. The HOXB13 G84E Mutation Is Associated with an Increased Risk for Prostate Cancer and Other Malignancies. Cancer Epidemiol. Biomarkers Prev. 2015; 24(9):1366-72. PMID: 26108461
  24. Cai, Q, et al. Germline HOXB13 p.Gly84Glu mutation and cancer susceptibility: a pooled analysis of 25 epidemiological studies with 145,257 participates. Oncotarget. 2015; 6(39):42312-21. PMID: 26517352
  25. Xu, J, et al. HOXB13 is a susceptibility gene for prostate cancer: results from the International Consortium for Prostate Cancer Genetics (ICPCG). Hum. Genet. 2013; 132(1):5-14. PMID: 23064873
  26. Ewing, CM, et al. Germline mutations in HOXB13 and prostate-cancer risk. N. Engl. J. Med. 2012; 366(2):141-9. PMID: 22236224
  27. Cheng, HH, et al. A Pilot Study of Clinical Targeted Next Generation Sequencing for Prostate Cancer: Consequences for Treatment and Genetic Counseling. Prostate. 2016; 76(14):1303-1311. PMID: 27324988
  28. Nicolosi P, et al. Prevalence of Germline Variants in Prostate Cancer and Implications for Current Genetic Testing Guidelines. JAMA Oncol. 2019;5(4):523-528. PMID: 30730552
  29. Na, R, et al. Germline Mutations in ATM and BRCA1/2 Distinguish Risk for Lethal and Indolent Prostate Cancer and are Associated with Early Age at Death. Eur. Urol. 2017; 71(5):740-747. PMID: 27989354
  30. Olsen, JH, et al. Breast and other cancers in 1445 blood relatives of 75 Nordic patients with ataxia telangiectasia. Br. J. Cancer. 2005; 93(2):260-5. PMID: 15942625
  31. Thompson, D, et al. Cancer risks and mortality in heterozygous ATM mutation carriers. J. Natl. Cancer Inst. 2005; 97(11):813-22. doi: 10.1093/jnci/dji141. PMID: 15928302
  32. di, Masi, A, Antoccia, A. NBS1 Heterozygosity and Cancer Risk. Curr. Genomics. 2008; 9(4):275-81. doi: 10.2174/138920208784533610. PMID: 19452044
  33. van, Asperen, CJ, et al. Cancer risks in BRCA2 families: estimates for sites other than breast and ovary. J. Med. Genet. 2005; 42(9):711-9. PMID: 16141007
  34. Gronwald, J, et al. Cancer risks in first-degree relatives of CHEK2 mutation carriers: effects of mutation type and cancer site in proband. Br. J. Cancer. 2009; 100(9):1508-12. PMID: 19401704
  35. Cybulski, C, et al. An inherited NBN mutation is associated with poor prognosis prostate cancer. Br. J. Cancer. 2013; 108(2):461-8. doi: 10.1038/bjc.2012.486. PMID: 23149842
  36. Robson, ME, et al. American Society of Clinical Oncology policy statement update: genetic and genomic testing for cancer susceptibility. J. Clin. Oncol. 2010; 28(5):893-901. PMID: 20065170
  37. Olivier, M, et al. Li-Fraumeni and related syndromes: correlation between tumor type, family structure, and TP53 genotype. Cancer Res. 2003; 63(20):6643-50. PMID: 14583457
  38. van, Os, NJ, et al. Health risks for ataxia-telangiectasia mutated heterozygotes: A systematic review, Meta-analysis and evidence-based guideline. Clin. Genet. 2015; :None. PMID: 26662178
  39. U.S. Department of Health and Human Services. What is Your Prostate? http://archive.ahrq.gov/patients-consumers/prevention/understanding/bodysys/edbody13.html Accessed January 2018.
  40. Karlsson, R, et al. A population-based assessment of germline HOXB13 G84E mutation and prostate cancer risk. Eur. Urol. 2014; 65(1):169-76. PMID: 22841674
  41. Ryan, S, et al. Risk of prostate cancer in Lynch syndrome: a systematic review and meta-analysis. Cancer Epidemiol. Biomarkers Prev. 2014; 23(3):437-49. PMID: 24425144
  42. Kote-Jarai, Z, et al. Prevalence of the HOXB13 G84E germline mutation in British men and correlation with prostate cancer risk, tumour characteristics and clinical outcomes. Ann. Oncol. 2015; 26(4):756-61. PMID: 25595936
  43. Stott-Miller, M, et al. HOXB13 mutations in a population-based, case-control study of prostate cancer. Prostate. 2013; 73(6):634-41. PMID: 23129385
  44. Liede, A, et al. Cancer risks for male carriers of germline mutations in BRCA1 or BRCA2: a review of the literature. J. Clin. Oncol. 2004; 22(4):735-42. PMID: 14966099

Assay and technical information

Invitae is a College of American Pathologists (CAP)-accredited and Clinical Laboratory Improvement Amendments (CLIA)-certified clinical diagnostic laboratory performing full-gene sequencing and deletion/duplication analysis using next-generation sequencing technology (NGS).

Our sequence analysis covers clinically important regions of each gene, including coding exons and 10 to 20 base pairs of adjacent intronic sequence on either side of the coding exons in the transcript listed below. In addition, the analysis covers the select non-coding variants specifically defined in the table below. Any variants that fall outside these regions are not analyzed. Any limitations in the analysis of these genes will be listed on the report. Contact client services with any questions.

Based on validation study results, this assay achieves >99% analytical sensitivity and specificity for single nucleotide variants, insertions and deletions <15bp in length, and exon-level deletions and duplications. Invitae's methods also detect insertions and deletions larger than 15bp but smaller than a full exon but sensitivity for these may be marginally reduced. Invitae’s deletion/duplication analysis determines copy number at a single exon resolution at virtually all targeted exons. However, in rare situations, single-exon copy number events may not be analyzed due to inherent sequence properties or isolated reduction in data quality. Certain types of variants, such as structural rearrangements (e.g. inversions, gene conversion events, translocations, etc.) or variants embedded in sequence with complex architecture (e.g. short tandem repeats or segmental duplications), may not be detected. Additionally, it may not be possible to fully resolve certain details about variants, such as mosaicism, phasing, or mapping ambiguity. Unless explicitly guaranteed, sequence changes in the promoter, non-coding exons, and other non-coding regions are not covered by this assay. Please consult the test definition on our website for details regarding regions or types of variants that are covered or excluded for this test. This report reflects the analysis of an extracted genomic DNA sample. In very rare cases, (circulating hematolymphoid neoplasm, bone marrow transplant, recent blood transfusion) the analyzed DNA may not represent the patient's constitutional genome.

Gene Transcript reference Sequencing analysis Deletion/Duplication analysis
ATM* NM_000051.3
ATR NM_001184.3
BRCA1* NM_007294.3
BRCA2* NM_000059.3
BRIP1 NM_032043.2
CHEK2 NM_007194.3
EPCAM* NM_002354.2
FANCA NM_000135.2
GEN1 NM_182625.3
HOXB13 NM_006361.5
MLH1* NM_000249.3
MSH2* NM_000251.2
MSH6 NM_000179.2
NBN NM_002485.4
PALB2 NM_024675.3
PMS2 NM_000535.5
RAD51C NM_058216.2
RAD51D NM_002878.3
TP53* NM_000546.5

ATM: Sequencing analysis for exons 24 includes only cds +/- 10 bp.
BRCA1: Sequence analysis includes +/- 20 base pairs of adjacent intronic sequence.
BRCA2: Sequence analysis includes +/- 20 base pairs of adjacent intronic sequence.
EPCAM: Analysis is limited to deletion/duplication analysis.
MLH1: Deletion/duplication analysis covers the promoter region.
MSH2: Analysis includes the exon 1-7 inversion (Boland mutation).
TP53: Deletion/duplication analysis covers the promoter region.