Dr Wise on the Importance of Genetic Testing in mCRPC

David R. Wise, MD, PhD, assistant professor, Department of Medicine, Department of Urology, NYU Grossman School of Medicine, director, Genitourinary Medical Oncology, NYU Langone Health’s Perlmutter Cancer Center, NYU Langone Health, discusses the importance of germline and somatic testing in patients with metastatic castration-resistant prostate cancer (mCRPC), and the need for improved testing practices in clinical practice. 

There are currently substantial gaps in the implementation of both hereditary and somatic testing for patients with mCRPC, despite efforts to increase the use of these tools in the clinic, Wise begins. Accordingly, it is essential to identify those who would most benefit from genetic testing in these patients, he says. This population includes men with metastatic disease, high-risk localized disease, and a significant family history of prostate cancer, Wise details. Patients of Ashkenazi Jewish descent, and those with a Gleason score of 6 or higher should also undergo hereditary testing, he adds.

More broad and consistent use of genetic testing could also improve the identification of individuals who harbor BRCA2mutations, Wise continues. However, only half of BRCA2 mutations in patients with prostate cancer can be attributed to hereditary predisposition, Wise says, explaining that the remaining half arise as new somatic mutations in the tumor alone. Accordingly, concurrent genetic and somatic testing is crucial to accurately identifying these mutations, he says. 

The integration of both hereditary and somatic testing is essential to harnessing the full potential of precision medicine, ensuring that individuals with prostate cancer receive tailored treatments based on their unique genetic profiles, Wise continues. In particular, patients with BRCA2 mutations and similar homologous recombination repair alterations may benefit from the use of PARP inhibitors, Wise states. This drug class has emerged as a promising intervention in this space and have thus far demonstrated anti-tumor activity in this population, Wise concludes.