Prostate cancer is a leading cause of death from cancer in the US and especially in the Philadelphia region. Consistently, Philadelphia has outpaced the state of PA and the nation in diagnoses and death from prostate cancer. A key area impacting prostate cancer risk and treatment is germline genetic testing, which involves testing for hereditary cancer genes. Genes such as BRCA2, BRCA1 and many other genes have been reported to raise the risk for prostate cancer and are increasingly informing treatment and management approaches. However, genetic testing of men for prostate cancer is still not common practice due to inconsistent guidelines and challenges to implementation of genetic counseling.
To address these challenges, experts at Sidney Kimmel Cancer Center – Jefferson Health and the Department of Urology at Thomas Jefferson University hosted the international Philadelphia Prostate Cancer Consensus Conference 2019 entitled Implementation of Germline Testing for Prostate Cancer. The Consensus Conference, co-chaired by Drs. Veda Giri, Karen Knudsen, and Leonard Gomella, had representation from many major Philadelphia healthcare institutions, such as University of Pennsylvania and Fox Chase Cancer Center, as well as centers around the United States, Europe, and Australia. Importantly, the conference addressed key gaps or areas in need of clarity regarding genetic testing for prostate cancer including: which men should undergo genetic testing for prostate cancer, which genes should be tested, how genetic results impact precision medicine and precision management across the stage spectrum, and the impact of genetic testing for cancer risk and screening for men and their families.
Key recommendations which were published in Journal of Clinical Oncology on June 9th include a strong endorsement to perform genetic testing of all men with metastatic prostate cancer to inform precision medicine or clinical trial eligibility, as well as men with a family history suggesting hereditary prostate cancer as well as other cancers such as breast, ovarian, pancreatic, and colon cancers, to inform active surveillance or screening discussions. Recommended priority genes for testing include BRCA2, BRCA1, and DNA mismatch repair genes in metastatic prostate cancer.
The Consensus recommendations come on the heels of two very important FDA approvals for drugs that target metastatic prostate cancer in men who carry BRCA mutations or mutations in other DNA repair genes. Two medications, rucaparib and olaparib, were granted FDA approval recently for treatment among men with specific genetic mutations due to clinical benefit, thus expanding precision medicine for prostate cancer. Therefore, the Conference results have significant impact for treatment decision-making for men with metastatic prostate cancer…..
Reference: Giri, et al. (2020) Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019. Journal of Clinical Oncology. DOI: 10.1200/JCO.20.00046
