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    Genetic testing for prostate Ca: What the experts say


    “An important take-home point for urologists is that in obtaining a family history in their patients, they should be eliciting information not only about prostate cancer but also about breast, ovarian, colorectal, uterine, and pancreatic cancers in both male and female relatives on their maternal and paternal sides,” said Dr. Giri.

    She added, “Hopefully, there will be tools developed that will facilitate incorporating this task routinely in a busy clinical practice.”

    If men with metastatic castrate-resistant prostate cancer (mCRPC) consider genetic testing, there was high level of consensus to test for mutations in BRCA1/2, and potentially ATM. There was a high level of agreement that men with prostate tumor sequencing showing mutations in specific hereditary cancer genes should have confirmatory germline genetic testing for prostate cancer predisposition.

    Recommendations on how genetic test results may inform prostate cancer screening focused on genes with higher level of risk for prostate cancer, such as BRCA2 and HOXB13, with moderate agreement to begin baseline PSA-based screening at age 40 or 10 years prior to the youngest prostate cancer diagnosis in a family, Dr. Giri said.

    Also see: Why you need to better counsel PCa patients on sexual function

    The panel also addressed the question of how genetic test results may be integrated into prostate cancer management. There was a high level of consensus for factoring in BRCA2 mutation status into management discussions of high-risk/advanced prostate cancer and a moderate level of consensus for incorporating ATM mutation status. There was a high level of consensus for factoring in BRCA1 and BRCA2 mutation status into discussions of treatment for mCRPC and a moderate level of consensus for considering ATM mutation status for such men.

    The panel identified a need for more data to determine whether BRCA2 or ATM mutations should be factored into decision–making for management of early-stage/localized prostate cancer. Genetic testing in African American males, cost-effectiveness and quality of life impact of genetic testing for prostate cancer, and the genetics of aggressive prostate cancer were also cited as topics in need of more study.

    Now that there is more specific guidance on genetic testing for prostate cancer, Dr. Giri said it is important for urologists to recognize that patients must have an understanding of the implications of genetic testing so they can make an informed decision about undergoing genetic evaluation. She encouraged clinicians to establish a close working relationship with a cancer genetics program.

    “The time is ripe for enhanced collaboration between urologists, cancer genetics, and translational research for greater impact on clinical decision-making for men with prostate cancer and their families,” Dr. Giri said.

    More from Urology Times:

    Pair of genes may predict prostate cancer metastasis

    PSA screening: What do you tell primary care docs?

    Prostate Ca test linked to reduction in biopsies

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