To evaluate evidence on germline and somatic genomic testing for patients with metastatic prostate cancer and provide recommendations.
A systematic review by a multidisciplinary panel with patient representation was conducted. The PubMed database was searched from January 2018 to May 2024. Articles were selected for inclusion if they reported on patients with metastatic prostate cancer who received a germline or somatic genomic test and/or made comparisons between those tests, reported detection rates, prognostic information, or treatment implications.
A total of 1,713 papers were identified in the literature search. After applying the eligibility criteria, 14 remained: eight systematic reviews and six clinical trials.
Patients with metastatic prostate cancer should undergo both germline and somatic DNA sequencing using panel-based assays. These tests can guide the use of poly(ADP-ribose) polymerase inhibitors, which have a survival benefit in metastatic castration-resistant prostate cancer. In addition, germline testing may have screening implications for additional cancers for patients and cascade testing implications for family members. The data supporting when to perform repeat testing and optimal tissue type to use (eg, primary tumor v metastatic biopsy versus circulating tumor DNA [ctDNA] testing) are more limited, but this panel recommends considering retesting in patients whose results were previously negative or uninformative, and to consider either a metastatic biopsy or ctDNA when a significant change in clinical status occurs. Next-generation genomic sequencing findings that are associated with prognostic only (and not predictive) value should not be used to guide treatment outside of a clinical trial.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2025 Jan 09 [Epub ahead of print]
Evan Y Yu, R Bryan Rumble, Neeraj Agarwal, Heather H Cheng, Scott E Eggener, Rhonda L Bitting, Himisha Beltran, Veda N Giri, Daniel Spratt, Brandon Mahal, Kevin Lu, Tony Crispino, Edouard J Trabulsi
University of Washington and Fred Hutchinson Cancer Center, Seattle, WA., American Society of Clinical Oncology, Alexandria, VA., Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT., University of Chicago, Chicago, IL., Duke Cancer Institute, Durham, NC., Dana Farber Cancer Institute, Boston, MA., Yale School of Medicine and Yale Cancer Center, New Haven, CT., UH Cleveland Medical Center, Cleveland, OH., UM/Sylvester Comprehensive Cancer Center, Miami, FL., Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung City, Taiwan., Patient Representative, Chapter President UsTOO Las Vegas, Prostate Cancer Education and Support, Las Vegas, NV., Jefferson Einstein Medical Center, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA.