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    How prostate cancer genetics will change front-line care

    Leonard G. Gomella, MDLeonard G. Gomella, MDOngoing genetic discoveries continue to enhance our knowledge of conditions such as prostate cancer. In this interview, Leonard G. Gomella, MD, provides an update on prostate cancer genetics, discusses the recent Prostate Cancer International Consensus Conference, and outlines why urologists should conduct more extensive family histories of their prostate cancer patients. Dr. Gomella is chairman of the department of urology and senior director for clinical affairs, Jefferson Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia. Dr. Gomella was interviewed by Urology Times Editorial Council member Stacy Loeb, MD, MSc, assistant professor of urology and population health at New York University Langone and the Manhattan VA, New York.

     

    What percentage of prostate cancer cases are caused by genetics?

    Most cases of prostate cancer are caused by genetic alterations. The problem is that when you break it down to very specific, identifiable, inherited prostate cancer risk genes, we have very few at the present time. All tumors are driven by genetics, but when you look at specific inherited risk, our current level of understanding is that about 10% to 15% of patients can have a clearly identifiable inherited component to their prostate cancer.

     

    This is a very active area of research. Please talk about what’s new and exciting in the world of prostate cancer genetics.

    The completion of the Human Genome Project in 2003 opened the door for not only basic science advances but drove the clinical applications of genomic and genetics. Urologists have recently become very familiar with the genomics of prostate tumors studying somatic mutations to help guide treatment decisions. The area we are now becoming interested in is known as germline testing or the study of inherited genetics. We’ve been able to identify more and more inherited genetic alterations in medicine. The traditional ones that we have the most familiarity with are the BRCA1 and BRCA2 abnormalities associated with hereditary breast and ovarian cancer. But it turns out that a significant number of men can also have BRCA1 or BRCA2 genetic alterations that can confer an increased risk of prostate cancer.

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    Several newer genes such as HOXB13 and ATM have also been identified as being associated with prostate cancer. Importantly, we’re recognizing that not only can prostate cancer run in families but it also can be related to breast cancer, ovarian cancer, pancreatic cancer, melanoma, and Lynch syndrome in other family members. This area of research is giving us some direction on how urologists can think about approaching our patients concerning the need for more detailed family histories.

    Lastly, genetic panels are now being offered by commercial laboratories specifically for prostate cancer. Urologists need to be aware that these panels are out there, and the best way to utilize these genetic testing panels is something we’re all going to have to learn in the coming years.

    Next: What was discussed at the Prostate Cancer International Consensus Conference

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