Hereditary Cancer Risk Assessment For Prostate Cancer Patients - Neal Shore
April 12, 2022
Neal Shore, MD, FACS, is the Medical Director of the Carolina Urologic Research Center. He practices with Atlantic Urology Clinics in Myrtle Beach, South Carolina
Alicia Morgans, MD, MPH, Genitourinary Medical Oncologist, Medical Director of Survivorship Program at Dana-Farber Cancer Institute, Boston, Massachusetts
Alicia Morgans: Hi, my name is Alicia Morgans, and I'm a geomedical oncologist at the Dana-Faber Cancer Institute.
Neal Shore: Hi. Neal Shore, I'm the CMO of urology and surgical oncology at Genesis Care, and I direct the Carolina Urologic Research Center. Thanks for having me, Alicia.
Alicia Morgans: Wonderful to have you here, and really great to talk about some of the work that you and the team presented at GU ASCO 2022. Can you fill us in?
Neal Shore: Yeah, I'd maybe just focus one particular presentation really proud of. We started about three years ago looking at starting up urology community practices that were treating prostate cancer that really had no genomic profile presence, no implementation, and this was a work sponsored by the folks at Myriad. And what we were able to do was do four weeks of education on just the importance of getting germline testing, and then follow with another four weeks of implementing and how to order tasks, how to get the reports, how to talk to patient.
And then ultimately what we presented at ASCO GU were our results. And what we found was that in doing physician surveys and patient surveys is that this was overwhelmingly well-received in terms of potential clinical utility, in terms of interpretation of the reports, dialoguing, communicating with patients, as well as the issues around family cascade testing.
And this was started literally somewhere about three to four years ago, and in the early days, and a lot's happened, right? We're living in really rapidly evolving times. And I think the conclusion is that genomic profiling in prostate cancer, it's not about if, it's when, and the answer is now.
One has to be thinking about optimal timing for getting both germline and somatic testing. Somatic; it could be tissue, it could be liquid, but there's so many clinical actionable moments, as well as research opportunities. And if you don't test, you don't know. And this has downstream implications for PARP inhibitors, there's two that have been approved. We found great, impressive phase three trial results at ASCO GU on the propel trial and the magnitude trial.
But our poster was essentially 15 different community urology sites, national distribution, and how they're continuing to do this. And if you look back at data registries, whether it's Flatiron or Optum, and just a few years ago, no one was doing this. So, I'm very proud of that effort. We've made great strides. I encourage all of my colleagues in urology and medical oncology to get into the world of genomic profiling. It only can potentially help patient care.
Alicia Morgans: So, did your study address some of the concerns that urologists or medical oncologists may have in terms of the cascade testing that you mentioned, and the genetic counseling that would be needed to try to help get to cascade testing, discuss those pathogenic variants with patients as well as with their family members?
Neal Shore: Yeah, you're absolutely right. There's a certain fear by their providers that, "Oh, my gosh, are their legal implications here? How will I talk about some of these test results?" It tends to be a little bit of a word salad soup of acronyms and people get flustered by it. And everyone tends to say, "Oh, I'm so busy. I can't do it," but there are ways to streamline it.
And that was the beauty of our study. We saw that practices were able to streamline, and there's always a little bit of a unique way that one can do it; whether you're incorporating advanced practice providers, nurses, other healthcare providers, physicians who are really interested.
And this was really one of the first trials to try and see, "Could we do it?" And we actually have the paper in submission, so I look forward to the audience, taking a read on it once we have it accepted, which will hopefully be very shortly, and learning the number of pathogenic variants that we found, what did you do with the information, and what did you do with the cascade testing, and how you can continue to evolve and improve.
Alicia Morgans: Well, that's fantastic. We will definitely have to talk again when that paper comes out, but I want to congratulate you and the team for the presentation that you had here at ASCO GU 2022, and for that upcoming publication.
Thank you for keeping in mind for all of us that the time is now for genetic testing and it is possible, and actually we can succeed quite effectively in our practices, no matter where we are. Thank you for giving us that example.
Neal Shore: Thanks for having me.