Dr. Shore on germline and somatic testing in prostate cancer

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"Then [we] also started looking at somatic testing, because if you only stop at germline testing, you miss another 50% of patients who would have somatic alterations who have resistant prostate cancer," says Neal D. Shore, MD, FACS.

In this video, Neal D. Shore, MD, FACS, highlights the background and notable findings from the study, “Influencing Best Practices for Genomic and Germline Testing in Urology,” for which he served as the lead author. Shore is the medical director of Carolina Urologic Research Center in Myrtle Beach, South Carolina, and the chief medical officer for urology and surgical oncology at GenesisCare.

Video Transcript:

Could you describe the background for this study?

I recognized, I think around 2016, that both germline and somatic genetic testing was going to be important because we were investigating targeted therapeutics that could improve precision-based treatment strategies, but also for enrolling patients into clinical trials. So, started getting very interested initially in what's known as hereditary risk scores or germline testing, the gene alterations we inherit from our mother and father, that have implications for the patient, but even have important implications for family members: children, siblings, and nieces and nephews. Germline testing is particularly enriched, as we saw in other tumor types before prostate cancer–breast, colorectal, ovarian, pancreatic. So, getting a good family history is important. Then also started looking at somatic testing, because if you only stop at germline testing, you miss another 50% of patients who would have somatic alterations who have resistant prostate cancer. We started doing this testing A, to help clinical trial accrual and answer questions regarding targeted precision-based therapies specifically for homologous recombination repair alterations, and even for patients who have DNA damage repair under the subheading of microsatellite instability. And then also for what people frequently called cascade family testing, to inform family members of a patient with prostate cancer that they too may have the alteration and therefore would benefit from earlier screening for certain cancers that they could be at risk for.

What were the notable findings from this study?

Our findings were very consistent with what others had published, with similar findings of around 20% to 25% of genetic alterations, combination either germline or somatic, for the castration resistant population, and about 10% in the metastatic hormone sensitive prostate cancer population, and about 5% overall, in high-risk, localized prostate cancer. That was a very important finding. For me, it correlated with other important papers that had already been published.

This transcription has been edited for clarity.

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