Opinion
Video
Tim Richardson, MD, on genetic testing in the era of targeted therapies
Author(s):
Key Takeaways
- Genetic testing in prostate cancer is crucial as targeted therapies advance, especially for castration-resistant stages.
- Early testing for somatic and germline mutations at metastatic diagnosis is recommended to guide treatment.
“Before long, what we do, how we do it, and when we do it might solely be based off of those genetic testing results,” says Tim Richardson, MD.
In this video, Tim A. Richardson, MD, shares his thoughts on the need for more genetic testing in prostate cancer as more targeted therapies become available. Richardson is the director of the advanced prostate cancer program and the radioligand therapy infusion program at Wichita Urology in Kansas.
Video Transcript:
Right now, most of the targeted therapies that we have are downstream—second-line, third-line, etc—when the patient is castration-resistant, but it also is a factor for the patient's family of risk of cancer. We typically recommend testing for somatic and germline mutations at diagnosis of metastatic disease. Some will do germline testing initially and then wait down the road for progression to do somatic; some will do the opposite.
In my practice, I try to do both early. With somatic testing, tissue tends to be a good lab to get, as opposed to a liquid biopsy. I want to use the tissue when it's fresh and new. So, at time of diagnosis of metastatic disease, I try to get somatic and germline. It's very important. We don't even really understand yet how important it's going to be, but down the road, everything is going to be targeted therapy. I think everyone agrees on that. We just don't know how and when. But there [are] new therapies coming out, for example, PTEN loss, AKT inhibitors, patients that maybe need to go on to taxotere-based chemotherapy, whether it's p53, [etc]. So, there's markers that that we don't even really use yet that are coming down the road that we know. Then obviously there [are] the main players with the BRCA1 and [BRCA]2, HRR mutations. Those can direct us to PARP inhibitors when the patient is castration resistant.
I think the biggest take-home message for the germline and somatic testing is we need to do more of it. Prostate is late to the game with that type of genetic testing. Breast cancer has been there for a long time. Ovarian cancer has been there for a long time, pancreatic cancer, etc. Prostate is late to the game. There's been a big push over the last 2 to 3 years to get urologists to think about genetic testing just like they think about doing a metastatic work-up for a high-risk patient. We're all used to ordering scans for a high-risk patient to make sure they don't have metastatic disease. I think genetic testing needs to move into that same paradigm where that comes into our head at the same time. We're getting there. It's picked up over the last 2 to 3 years. We still haven't caught up with those people that are treating breast, ovarian, etc. It's been ingrained in their head for years and years, but we need to keep pushing that, because before long, what we do, how we do it, and when we do it might solely be based off of those genetic testing results.
This transcript was AI generated and edited by human editors for clarity.
