Germline and tumour genetic testing in prostate cancer (PCa) is becoming more broadly accepted, but testing indications and clinical consequences for carriers in each disease stage are not yet well defined.
To determine the consensus of a Dutch multidisciplinary expert panel on the indication and application of germline and tumour genetic testing in PCa.
The panel consisted of 39 specialists involved in PCa management. We used a modified Delphi method consisting of two voting rounds and a virtual consensus meeting.
Consensus was reached if ≥75% of the panellists chose the same option. Appropriateness was assessed by the RAND/UCLA appropriateness method.
Of the multiple-choice questions, 44% reached consensus. For men without PCa having a relevant family history (familial PCa/BRCA-related hereditary cancer), follow-up by prostate-specific antigen was considered appropriate. For patients with low-risk localised PCa and a family history of PCa, active surveillance was considered appropriate, except in case of the patient being a BRCA2 germline pathogenic variant carrier. Germline and tumour genetic testing should not be done for nonmetastatic hormone-sensitive PCa in the absence of a relevant family history of cancer. Tumour genetic testing was deemed most appropriate for the identification of actionable variants, with uncertainty for germline testing. For tumour genetic testing in metastatic castration-resistant PCa, consensus was not reached for the timing and panel composition. The principal limitations are as follows: (1) a number of topics discussed lack scientific evidence, and therefore the recommendations are partly opinion based, and (2) there was a small number of experts per discipline.
The outcomes of this Dutch consensus meeting may provide further guidance on genetic counselling and molecular testing related to PCa.
A group of Dutch specialists discussed the use of germline and tumour genetic testing in prostate cancer (PCa) patients, indication of these tests (which patients and when), and impact of these tests on the management and treatment of PCa.
European urology open science. 2023 Jan 25*** epublish ***
Niven Mehra, Iris Kloots, Michiel Vlaming, Shafak Aluwini, Els Dewulf, Daniela E Oprea-Lager, Henk van der Poel, Herman Stoevelaar, Derya Yakar, Chris H Bangma, Elise Bekers, Roderick van den Bergh, Andries M Bergman, Franchette van den Berkmortel, Steve Boudewijns, Winand N M Dinjens, Jurgen Fütterer, Tom van der Hulle, Guido Jenster, Leonie I Kroeze, Michel van Kruchten, Geert van Leenders, Pim J van Leeuwen, Wendy W J de Leng, R Jeroen A van Moorselaar, Walter Noordzij, Rogier A Oldenburg, Inge M van Oort, Irma Oving, Jack A Schalken, Ivo G Schoots, Ed Schuuring, Robert J Smeenk, Ben G L Vanneste, Erik Vegt, André N Vis, Kim de Vries, Peter-Paul M Willemse, Maurits Wondergem, Margreet Ausems
Department of Medical Oncology, Radboud UMC, Nijmegen, The Netherlands., Division Laboratories, Pharmacy and biomedical Genetics, Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands., Department of Radiation Oncology, UMCG, Groningen, The Netherlands., Centre for Decision Analysis & Support, Ismar Healthcare NV, Lier, Belgium., Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands., Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Department of Radiology, UMCG, Groningen, The Netherlands., Department of Urology, Erasmus MC, Rotterdam, The Netherlands., Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Department of Urology, St. Antonius Ziekenhuis Nieuwegein, The Netherlands., Department of Medical Oncology and Oncogenomics, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Department of Internal Medicine, Zuyderland MC, Sittard, The Netherlands., Department of Medical Oncology, Bravis Hospital, Roosendaal, The Netherlands., Department of Pathology, Erasmus MC, Rotterdam, The Netherlands., Department of Medical Imaging, Radboud UMC, Nijmegen, The Netherlands., Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands., Department of Pathology, Radboud UMC, Nijmegen, The Netherlands., Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands., Department of Pathology, UMC Utrecht, Utrecht, The Netherlands., Department of Urology, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands., Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands., Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands., Department of Urology, Radboud UMC, Nijmegen, The Netherlands., Department of Internal Medicine, Ziekenhuis Groep Twente, Almelo, The Netherlands., Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands., Department of Radiation Oncology, Radboud UMC, Nijmegen, The Netherlands., Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht UMC, Maastricht, The Netherlands., Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands., Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands., Department of Urology, Cancer Center, UMC Utrecht, Utrecht, The Netherlands., Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.