Genetic testing in advanced prostate cancer is rapidly moving to become standard of care. Testing for genetic alterations in genes involved in DNA repair pathways, particularly those implicated in the homologous recombination repair (HRR) pathway, in patients with metastatic prostate cancer (mPCa) can inform selection of optimal therapies, as well as provide information about familial cancer risks; however, there are currently no consistent Canadian guidelines in place for genetic testing in mPCa.
A multidisciplinary steering committee guided the process of an environmental scan to define the current landscape, as well as the perceived challenges, through interviews with specialists from 14 sites across Canada. The challenges most commonly identified include limited testing guidelines and protocols, inadequate education and awareness, and insufficient resources. Following the environmental scan, an expert multidisciplinary working group with pan-Canadian representation from medical oncologists, urologists, medical geneticists, genetic counsellors, pathologists, and clinical laboratory scientists convened in virtual meetings to discuss the challenges in implementation of genetic testing in mPCa across Canada.
Key recommendations from the working group include implementation of germline and tumor HRR testing for all patients with mPCa, with a mainstreaming model in which non-geneticist clinicians can initiate germline testing. The working group defined the roles and responsibilities of the various healthcare providers (HCPs) involved in the genetic testing pathway for mPCa patients. In addition, the educational needs for all HCPs involved in the genetic testing pathway for mPCa were defined.
As genetic testing for mPCa becomes standard of care, additional resources and investments will be required to implement the changes that will be needed to support the necessary volume of genetic testing, to ensure equitable access, and to provide education to all stakeholders.
Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2022 Oct [Epub]
Shamini Selvarajah, Kasmintan A Schrader, Michael P Kolinsky, Ricardo A Rendon, Soufiane El Hallani, Neil E Fleshner, Sebastien J Hotte, Justin Lorentz, Karen Panabaker, Renée Perrier, Frédéric Pouliot, Alan Spatz, Stephen Yip, Kim N Chi
Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network (UHN), Toronto, ON, Canada., Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., Cross Cancer Institute and Department of Oncology, University of Alberta, Edmonton, AB, Canada., Department of Urology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada., Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada., Division of Urology, Departments of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada., Department of Oncology, McMaster University, Hamilton, ON, Canada., Genetics and High Risk Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada., Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, ON, Canada., Department of Medical Genetics, Alberta Children's Hospital and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada., Divison of Urology, Department of Surgery, CHU de Québec and Laval University, Quebec, QC, Canada., Department of Laboratory Medicine, McGill University Health Centre, Department of Pathology, McGill University, Research Molecular Pathology Center, Lady Davis Institute, Montreal, QC, Canada., Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada., BC Cancer, Vancouver, BC, Canada.