Copenhagen, Denmark (UroToday.com) Dr. Hamdy presented is view on why it is still not the right time for genetic testing of metastatic castrate resistant prostate cancer (MCRPC) patients. There are 5 things an MCRPC patient wants to know:
The most common germline mutations and somatic aberrations in metastatic prostate cancer are shown in figure 1 and 2, respectively. The current NCCN genetic guidelines recommends when genetic testing should be performed, to whom, and which genetic tests should be done (Figure 3). The Philadelphia 2017 consensus -driven framework for multigene testing for inherited prostate cancer also has elaborated recommendation on genetic testing (Figure 4).
- How bad is his disease?
- Is it going to kill him?
- What are the best treatment combinations?
- What are the effects of the treatments? And what if they fail?
- How can his male relatives be counseled?
Dr. Hamdy concluded his interesting talk with the following key questions, which are still unanswered:
- To whom should we advise germline testing for BRCA genes only?
- Should we advise testing for somatic aberrations? And in which method? (targeted sequencing? Whole genome sequencing? Whole exome sequencing?)
- What should be tested? Fresh material? formalin-fixed paraffin-embedded (FFPE) tissue?
- How will the results affect immediate treatment advice? Treatment failures? Family genetic counselling and ethics?
Figure 2: Common somatic aberrations in metastatic prostate cancer;
Figure 3: NCCN guidelines recommendations on genetic testing:
Figure 4: The Philadelphia 2017 consensus-driven framework for multigene testing for inherited prostate cancer recommendations on genetic testing (green – wide consensus, yellow –not a wide consensus)
Presented by: F.C. Hamdy, MD, Oxford, Great Britain
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark