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Spotlight

GU Cancers Symposium

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Clinical Focus

“Vanderbilt researchers are participating in numerous projects related to PRS and disease risk; studies such as this highlight the importance of evaluating whether novel clinical tools actually enhance care,” said Kerry Schaffer, MD.

Study evaluates polygenic risk score for prostate cancer risk prediction

The application is supported by findings from the phase 3 MAGNITUDE study.

FDA approval sought for niraparib/abiraterone tablet for BRCA+ mCRPC

The GPS test uses a 17-gene signature to predict disease aggressiveness and help guide treatment decisions for patients with localized prostate cancer.

UnitedHealthcare will cover Genomic Prostate Score test

IsoPSA is included in the National Comprehensive Cancer Network Prostate Cancer guidelines for early detection of the disease. 

Diagnostics companies enter agreement to expand access to blood-based IsoPSA test

Here is some of the top content on genomic testing from the past year. 

Videos

There currently 2 PARP inhibitors—olaparib and rucaparib—approved as monotherapies for the treatment of patients with metastatic castration-resistant prostate cancer.

Dr. Zhang on combining PARP inhibitors with hormonal agents in prostate cancer

 discusses next steps and take-home messages from the study, "Factors related to men’s experience with prostate cancer germline testing," which was presented at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium. Giri is division chief of Clinical Cancer Genetics for Yale Cancer Center and Smilow Cancer and assistant director of Clinical Cancer Genetics for Yale Cancer Center, New Haven, Connecticut.

What are the next steps for the PROGRESS registry?

What we really want to do is have more enhanced engagement of broader populations. We achieved our first round of accrual of 500 males into the PROGRESS registry. What we'd like to do now is really open the registry and have greater participation of African American and Asian males in this registry to be able to get deeper insights across populations. We want to then develop resources from the information that we already have. The purpose of this was to have this information and data supporting the development of resources. Some of those resources have already launched; we've had some webinars to our participants, to be able to talk more about some of the information that they've indicated that they need to [learn about]. [We're also] thinking about ways of supporting men in this process through the different aspects of their care, and also thinking of using technological tools, resources for their families in terms of the discussion of this information, and provider resources as well. So we're going to be working together as a team to come up with these sorts of resources. Funding, of course, will be really important for these types of avenues. We're so grateful to the Department of Defense for funding this first round of the PROGRESS registry, without which we could not have come to this point with this work. I have to also thank all of my collaborators and investigators across the US and the participants themselves for taking the time to engage with us.

What is the take-home message for the practicing urologist?

It is really important to think about germline testing for patients in urology practices. It really is now standard of care, even if it doesn't directly affect the treatment at the point in time that they're seeing them. This could be the doorway into uncovering hereditary cancer risks in their families. And so this needs to be considered in their care even from a hereditary cancer standpoint. The other takeaway point is to think about how to deliver this information to patients, whether that means partnering with a genetic counseling program, whether it means bringing in validated technology tools like web tools or videos into their practice, so that patients can hear this information, having staff in the office that can answer questions for patients so that they really can make an informed decision for genetic testing, and then really ensuring that the genetic testing is comprehensive, clinical grade at a reputable, experienced laboratory. Those are some of the clinical takeaways that are really important. I do think that this requires partnership across the board with genetics programs and specialists. Finding that partnership and collaboration is really important for patient care.

Is there anything else you would like to add?

I think that we'd be looking to collaborate more broadly as well. We'd love to partner with urology practices and academic centers, to have even greater engagement in the next step of our PROGRESS registry, and also for resource development. We know thatthis has to be with team input to think about what resources really can work for patients and for urologists as well.

This transcription was edited for clarity.

“What we really want to do is have more enhanced engagement of broader populations,” says Veda Giri, MD.

Dr. Giri on next steps for the PROGRESS registry evaluating prostate cancer genetic testing

 discusses notable findings from the study, "Factors related to men’s experience with prostate cancer germline testing," which was presented at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium. Giri is division chief of Clinical Cancer Genetics for Yale Cancer Center and Smilow Cancer and assistant director of Clinical Cancer Genetics for Yale Cancer Center, New Haven, Connecticut.

The results were actually very interesting, some of which were surprising. Some of [the results] were reassuring in terms of how this field is rolling out. Given the fact that this field has really expanded, we see that patients are engaging with genetic testing in various different ways, whether it's by being referred to see a genetic counselor or a genetic professional, whether that information and testing is being delivered by their treating physicians, whether they're going straight to genetic testing laboratories and receiving some of that information from the laboratories and moving forward with testing. There is some direct-to-consumer marketing that's going on. So we wanted to explore a lot of these modes of delivery of genetic evaluation to men who have undergone prostate cancer genetic testing.

And just to give you some idea, because this informs the results, is that they took surveys about their knowledge of cancer genetics [and] their satisfaction with the process of how they went through their genetic evaluation and testing. [We asked], did they intend to share their results with their family members and their health care providers, and [we also asked about] their attitude toward it; did they find this was beneficial to them in terms of their treatment and care? We also put this in the context of medical literacy and numeracy, knowing that we have to be thinking about broad populations and making the information understandable.

So with all of that in mind, we recruited 500 participants to the PROGRESS registry. 87.7% of them were Caucasian men. The majority had college degrees. 76% indicated that they were married, and so we're also looking [at] ways to engage partners, families, friends, a network of support to help these individuals if there's challenges that they come across. In terms of prostate cancer, 46.9% of them reported a prostate cancer diagnosis. So this really was a nice split in terms of men that had prostate cancer diagnosed already and those individuals who did not and maybe were having genetic testing to help inform their risk of prostate cancer. Of those that had prostate cancer, 24.4% of them had a Gleason score greater than or equal to 8. The majority of them reported that they actually had some family member with any sort of family history of cancer reported. So there may have been a family history of breast cancer or prostate cancer, ovarian cancer, etc, in these families.

We asked them for information about their genetic results as well. 27.9% had pathogenic or likely pathogenic variants that were identified. 14.7% had variants of uncertain significance that they reported in their genetic testing. But importantly, and this was one of the surprising findings, is that 9.9% did not know their genetic results. These were individuals whose results had been returned to them. [We'd like to get] a better idea of why they couldn't recall their information. What other factors might be at play there? Maybe they're getting a lot of information about their treatment and screening and it's just a lot to process. We actually had a good sample of distribution for how these men received their genetic evaluation. Some of the most common ways that they indicated for genetic evaluation was that they met with a genetics professional, whether that was in person or by phone, followed by having their doctor discuss genetic testing with them. Another one was using a website that discussed genetic testing. This was very interesting to see and to dive deeper; was this through genetic laboratories or through other avenues of how technology may be being used now to help deliver genetic information to patients? When we looked at this information, what was interesting is that 8.1% of individuals said that they did not know how they received their pretest information for genetic testing. Did they receive information? If they didn't, that's something that definitely needs to be addressed in terms of adhering to standard of care. But if they did, then that means that the information needs to be reinforced, because for some reason, they're not retaining the fact that they got this information.

And then when we looked at some of the factors related to patient-reported outcomes, [we found] that satisfaction was lower for the Asian participants. This is something we definitely need to explore more about this process. What are the needs of Asian individuals who are seeking genetic testing, so that we can develop the proper resources and supports for them. Satisfaction was higher for those individuals who received their pretest information for genetic testing from genetics professionals or by their doctors. That was reassuring, because this is actually how things are rolling forward in practice. Also, decisional conflict was lower for those individuals who had discussions with a genetics professional, even if it was by phone. So that was really good to hear in terms of having greater access to genetic services, where in-person may not always be possible. This was expected, [but] cancer genetics knowledge was actually higher for those with higher education, with a family history of prostate cancer, or those that actually had mutations identified. It was also higher for those individuals who had their genetics discussions, even by their doctors, or by genetics professionals, even if that was by a genetics laboratory. And then, of course, those who felt that this was most beneficial were those who had mutations identified. Where it may not feel as beneficial is if there's uncertain findings, or negative results. Those were some of the key results.

We still need to dive into some of the root causes for some of these findings. But receiving pretest information by a genetics professional, whether that's by phone or in person, or by doctors, is reported to have higher satisfaction and lower decisional conflict. And that's really great because it does support these alternate delivery models to enhance access to genetic testing, and also supports these points of care approaches in terms of where the testing is happening in the health care providers' offices, and really ensuring that patients and providers practices have the right resources to be able to engage in this discussion. I think what we really need to do is study broader populations; we need to dive deeper into some of these challenges that are faced by broad populations, such as some of the results we saw for Asian men who participated in this study. We also need to have broader representation. We definitely need to have greater engagement of African American men, Asian men, etc, to make sure that the results are translatable, and that we can develop proper resources across populations. That's going to be an important next step for us to do. We're planning to publish our findings first and really launch into the next steps at the same time.

"Given the fact that this field has really expanded, we see that patients are engaging with genetic testing in various different ways," says Veda Giri, MD.

Genetic testing for prostate cancer: What findings from PROGRESS registry reveal

 discuss the findings of the paper, “Usefulness of podcasts to provide public education on prostate cancer genetics,” which was published in 

). The podcasts are available online now (https://open.spotify.com/show/4FYxW2zUgJmW8wkVbiOXBb?si=dca177dda31443f6).

Giri is division chief of Clinical Cancer Genetics for Yale Cancer Center and Smilow Cancer and assistant director of Clinical Cancer Genetics for Yale Cancer Center, New Haven, Connecticut. Loeb is a professor in the departments of urology and population health at the NYU Grossman School of Medicine, New York City, New York.

This whole endeavor has been so fruitful from our end. We really learned a lot by having these in-depth discussions with health care providers, patients with a family member, and genetic counselors. It really highlights the importance of these types of team-based approaches, with doctors, with genetic counselors, with patients, to approach this field. It takes all of us to think about ways of disseminating this information, whether it's in our networks, in our communities, and expanding upon the use of technology to be able to disseminate this information. We're really grateful for funding from the Department of Defense for an idea development award that funded this project, and to be able to use technology to disseminate this information. We wouldn't be able to do it without the funding, and, of course, then collaboration with experts like Dr. Loeb, and other individuals who took part in the podcast, so we'd really like to thank everyone who agreed to be interviewed for the podcast. We hope to do more.

I agree. I think it's very topical, especially in the current climate with so much misinformation that's circulating and the difficulty that patients and family members have finding high-quality sources of information. Things like podcasts and social media are so ubiquitous, and so we need to leverage these great platforms to put out high-quality information with experts that people can listen to from home or on the go and get the information that they need. It's exciting to see the study results that the podcasts were really well received and that people really learned a lot about genetics from them. I hope that in the future that more health care providers and scientists will use these great platforms toshare more evidence-based information with the public

“We need to leverage these great platforms to put out high-quality information with experts that people can listen to from home or on the go and get the information that they need,” says Stacy Loeb, MD, MSc.

Dr. Giri and Dr. Loeb discuss prostate cancer genetic testing podcast series

 describe the contents of a new podcast series that offers information on genetic testing for prostate cancer. A paper detailing patient reception to the podcasts was recently published in 

 (https://rdcu.be/c3UEl), and new episodes of the podcast will drop on Tuesdays (https://open.spotify.com/show/4FYxW2zUgJmW8wkVbiOXBb?si=dca177dda31443f6).

 So far there are 6 episodes. Two [feature] medical oncologists talking about the impact that genetics has for precision management of prostate cancer and also how it ties in with syndromes that run in families like hereditary breast and ovarian cancer syndrome and Lynch syndrome. There are 2 episodes with genetic counselors. Those are very interesting because they talk about what happens in genetic counseling sessions, what are the different types of genetic tests, and in particular, what is different about the direct-to-consumer tests that people can do at home like 23andme compared with the tests that would be ordered in a clinical setting for cancer genetics. Finally, there are 2 that are personal narratives with a patient and his son to talk about their experience going through the process, what it was like getting the counseling and testing and how they felt when they found out that they were 

 carriers and the impact that that had for their life. So I think this is a nice cluster of podcasts that really go at this from different angles, from the personal aspect all the way through to the nuts and bolts and the clinical implications.

 Yes, and I think the personal stories of the patient and his son are very impactful, and I think they bring an important angle to this field, which is when we do genetic testing for males in the context of prostate cancer, we can uncover genetic information like in 

, [which are] classically thought of as gene mutations associated with breast and ovarian cancer risk for females, but how important it is for males to also think about this and thinking of family history of cancers in general, across gender [and] across generations. Those things were really highlighted in the patient stories.

This transcript has been edited for clarity.

“I think this is a nice cluster of podcasts that really go at this from different angles,” says Stacy Loeb, MD, MSc.

Prostate cancer genetics podcast series features medical oncologists, genetic counselors, and a patient

discuss a new podcast series that offers information on genetic testing for prostate cancer. A paper detailing patient reception to the podcasts was recently published in 

), and new episodes of the podcast will drop on Tuesdays (

https://open.spotify.com/show/4FYxW2zUgJmW8wkVbiOXBb?si=dca177dda31443f6

 What happened was, there's just been so much recently about prostate cancer genetics. It's been a really hot topic, because previously, it wasn't known that so much prostate cancer was caused by genetic factors. So many patients with prostate cancer qualify for genetic testing, but it's currently underutilized. We've been doing some research [into] what are some of the reasons why it's being underutilized. Some of the providers who we talked to in that research suggested that maybe a podcast series would be a good way to share more information about prostate cancer genetics.

 As Dr Loeb said, this field of genetic testing, particularly for prostate cancer, has really come to the forefront. It's really important for doctors, patients, and the community to understand, what are we talking about? What does this entail? How can we communicate information about genetic testing for prostate cancer through a medium that really has been on the upswing in terms of podcasts? So we thought we would merge the 2 together in terms of delivering this information about genetic testing for prostate cancer through a [medium] like podcasts, pilot that, and see what uptake and feedback [we would receive].

“So many patients with prostate cancer qualify for genetic testing, but it's currently underutilized,” says Stacy Loeb, MD, MSc.

Podcast series seeks to educate patients on genetic testing for prostate cancer

, discusses the significance of optimizing patient selection when using PARP inhibitors for prostate cancer. Using these agents in patients unlikely to benefit adds unnecessary pill, toxicity, and financial burdens to the recipient, explains Choudhury. He notes the importance of finding biomarkers to facilitate appropriate patient selection. 

Choudhury is a medical oncologist and clinical/translational investigator within the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, and currently serves as Chair of the Gelb Center for Translational Research.

“We don’t want to subject patients to a therapeutic strategy that they are unlikely to benefit from,” says Atish D. Choudhury, MD, PhD.

Importance of appropriate patient selection for PARP inhibitors in prostate cancer

 discuss the European Urology paper “Genetic Risk Prediction for Prostate Cancer: Implications for Early Detection and Prevention,” for which they served as coauthors. Giri is division chief of Clinical Cancer Genetics for Yale Cancer Center and Smilow Cancer and assistant director of Clinical Cancer Genetics for Yale Cancer Center, New Haven, Connecticut. Loeb is a professor in the departments of urology and population health at the NYU Grossman School of Medicine, New York City, New York.

“It really was a multidisciplinary effort to pull the data together [and] provide the clinical implications [of] the genetic markers,” says Veda N. Giri, MD.

Experts study implications of genetic markers in prostate cancer

, describes biomarkers as the critical component to advancing the treatment paradigm for patients with metastatic castration-sensitive prostate cancer. Dorff is a medical oncologist, section chief of Genitourinary Disease Program, and associate professor in the Department of Medical Oncology & Therapeutics Research at City of Hope Comprehensive Cancer Center.

Tanya Dorff, MD, explains how the next frontier in mCSPC will be the ability to select patients for treatment based more on molecular stratification and not only on disease volume or metachronous vs synchronous presentation.

Dr. Dorff on greatest unmet need in metastatic castration-sensitive prostate cancer

, discusses FDA-approved treatments currently available for prostate cancer that are selected based on genetic testing of patients. Antonarakis is associate director for Translational Research at the University of Minnesota Medical School Masonic Cancer Center, as well as the Clark Endowed Professor of Medicine and director of Genitourinary Oncology in the Department of Medicine’s Division of Hematology, Oncology, and Transplantation

“At this time, there are at least 2 classes of therapeutic agents which are used for patients with certain germline or somatic genetic mutations,” says Emmanuel S. Antonarakis, MD.