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Hereditary Prostate Cancer Testing in Practice

Panelists: Raoul S. Concepcion, MD, FACS, Comprehensive Prostate Center; Daniel George, MD, Duke Cancer Institute; Alec Koo, MD, Skyline Urology; Phillip Koo, MD, MD Anderson Cancer Center; Neal D. Shore, MD, FACS, Carolina Urologic Research Center
Published: Monday, May 14, 2018



Transcript: 

Raoul S. Concepcion, MD, FACS: I think that’s a very important point, and I think it will change how all of us practice—this incorporation of hereditary testing and taking a much better family history. Dan, as you said, it’s no longer about whether you’re African American or if you have a family history of prostate cancer. It’s all of these other “hereditary tumors” that we never thought prostate cancer fit into. You test because of determining treatment for the patient. The more sticky point, that many urologist groups may not be prepared to handle, but I want your input on, Alec, is family counseling. Are you routinely incorporating this in your Advanced Prostate Cancer Center and in your practice, in general?

Alec Koo, MD: This is the challenge. This is a hurdle that we have. We have new guidelines that indicate that all castration-resistant prostate cancer patients and other prostate cancer patients with certain family history should now be tested. And once you start your test, the family members of those who test positive should be tested. We’re in the process of trying to implement that. The resources, in terms of genetic counseling, are a challenge. We don’t have a good systemized solution yet. Several months ago, Neal and I were talking with various vendors, genetic testing companies, to see if there were some methods that we could facilitate in the community urology groups, in compliance with the testing guidelines.

Raoul S. Concepcion, MD, FACS: Last year, the folks at Thomas Jefferson University put together that first comprehensive genetic test. They came out with a recent paper to summarize how urologists, especially those who are managing prostate cancer, should be looking at this. What sort of genes should they be looking at? When should you test? Can you expand on that a little bit?

Neal D. Shore, MD, FACS: Yes. There’s a recent paper in the Journal of Clinical Oncology of that Philadelphia Prostate Cancer Consensus Conference. It was really wonderfully instituted by the folks at Thomas Jefferson University. The authors included Veda Giri, William Kelly, Karen Knudsen, and Leonard Gomella. I encourage everybody to read that paper, which worked at trying to get consensus. It was not always so easy to get consensus. At the LUGPA level, we’re going to have 3 different initiatives this year on hereditary prostate cancer testing with the various vendors that are very ensconced in this field right now. This is incredibly important because we’re really at the beginning of understanding the importance, as well as some of the challenges, in doing hereditary prostate cancer testing.

We don’t want to make the same mistakes, and we can learn from what’s happened from our breast cancer surgeons and our medical oncologists as it relates to hereditary testing for breast and ovarian cancer, etc. I think it’s very important for our listening urologic audience to understand that there are a lot of really great initiatives. Probably, the best low-hanging fruit, and the easiest, is getting a better family history. We’ve really never done a very good job at doing this. This is really important. I’m really excited, at the LUGPA level, that we’re going to have 3 different hereditary prostate cancer initiatives and more educational learnings. So, I would highly encourage the urologists in the community to recognize that this is something that they really want to be focusing on.

Transcript Edited for Clarity 

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Transcript: 

Raoul S. Concepcion, MD, FACS: I think that’s a very important point, and I think it will change how all of us practice—this incorporation of hereditary testing and taking a much better family history. Dan, as you said, it’s no longer about whether you’re African American or if you have a family history of prostate cancer. It’s all of these other “hereditary tumors” that we never thought prostate cancer fit into. You test because of determining treatment for the patient. The more sticky point, that many urologist groups may not be prepared to handle, but I want your input on, Alec, is family counseling. Are you routinely incorporating this in your Advanced Prostate Cancer Center and in your practice, in general?

Alec Koo, MD: This is the challenge. This is a hurdle that we have. We have new guidelines that indicate that all castration-resistant prostate cancer patients and other prostate cancer patients with certain family history should now be tested. And once you start your test, the family members of those who test positive should be tested. We’re in the process of trying to implement that. The resources, in terms of genetic counseling, are a challenge. We don’t have a good systemized solution yet. Several months ago, Neal and I were talking with various vendors, genetic testing companies, to see if there were some methods that we could facilitate in the community urology groups, in compliance with the testing guidelines.

Raoul S. Concepcion, MD, FACS: Last year, the folks at Thomas Jefferson University put together that first comprehensive genetic test. They came out with a recent paper to summarize how urologists, especially those who are managing prostate cancer, should be looking at this. What sort of genes should they be looking at? When should you test? Can you expand on that a little bit?

Neal D. Shore, MD, FACS: Yes. There’s a recent paper in the Journal of Clinical Oncology of that Philadelphia Prostate Cancer Consensus Conference. It was really wonderfully instituted by the folks at Thomas Jefferson University. The authors included Veda Giri, William Kelly, Karen Knudsen, and Leonard Gomella. I encourage everybody to read that paper, which worked at trying to get consensus. It was not always so easy to get consensus. At the LUGPA level, we’re going to have 3 different initiatives this year on hereditary prostate cancer testing with the various vendors that are very ensconced in this field right now. This is incredibly important because we’re really at the beginning of understanding the importance, as well as some of the challenges, in doing hereditary prostate cancer testing.

We don’t want to make the same mistakes, and we can learn from what’s happened from our breast cancer surgeons and our medical oncologists as it relates to hereditary testing for breast and ovarian cancer, etc. I think it’s very important for our listening urologic audience to understand that there are a lot of really great initiatives. Probably, the best low-hanging fruit, and the easiest, is getting a better family history. We’ve really never done a very good job at doing this. This is really important. I’m really excited, at the LUGPA level, that we’re going to have 3 different hereditary prostate cancer initiatives and more educational learnings. So, I would highly encourage the urologists in the community to recognize that this is something that they really want to be focusing on.

Transcript Edited for Clarity 
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