EAU 2018: Case-Based Debate BRCA 1/2 Testing Before Treatment of Metastatic Castration-Resistant Prostate Cancer - Not Yet

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:

  1. How bad is his disease?
  2. Is it going to kill him?
  3. What are the best treatment combinations?
  4. What are the effects of the treatments? And what if they fail?
  5. How can his male relatives be counseled?
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).

Dr. Hamdy concluded his interesting talk with the following key questions, which are still unanswered:

  1. To whom should we advise germline testing for BRCA genes only?
  2. Should we advise testing for somatic aberrations? And in which method? (targeted sequencing? Whole genome sequencing? Whole exome sequencing?)
  3. What should be tested? Fresh material? formalin-fixed paraffin-embedded (FFPE) tissue?
  4. How will the results affect immediate treatment advice? Treatment failures? Family genetic counselling and ethics?
Figure 1: Common germline mutations in metastatic prostate cancer:
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