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Genomic & Genetic Testing

What is Genetic Testing?

Genetic testing identifies gene mutations that can impact patients and their families. Two different types of genetic tests in prostate cancer are Germline and Somatic. These are clinical tests that are used by physicians to develop treatment plans. Understanding the differences between these tests is important to decide which one is right for you in your prostate cancer journey.

Germline Testing

Pedigree of the 1 in 6 men with prostate cancer who have inherited a gene mutation that may have caused their cancer.Up to 1 in 6 men with prostate cancer inherited a gene mutation that may have caused their prostate cancer. If prostate cancer was caused by an inherited gene mutation it is defined as hereditary cancer. Men with hereditary prostate cancer are 6 times more likely to die from their disease and 4 times more likely to develop metastasis within 5 years. Identifying if you have a germline mutation impacts current and future treatment decisions. Target therapies are available for men with a genetic mutation and metastatic castrate-resistant prostate cancer. Germline testing also provides family members with valuable information regarding their cancer risks. Family members of men with hereditary cancer have a 50% chance of having the same genetic mutation. Germline testing can help family members know if they should be also be tested or take preventive measures to avoid developing cancer. All men with prostate cancer should consider genetic testing. Download a germline patient education guide here and learn more about germline testing here.

 

To learn more about genetic testing, watch this interview between ZERO’s VP of Patient Programs & Education, Shelby Moneer, and Dr. Todd Cohen, VP of Medical Affaris/Medical Director of Urology – Myriad Genetics.

See how germline testing impacted Ed Hoppe and his family in this video:

Somatic Testing

Somatic mutations occur over an individual’s lifetime. They are only present in the tumor and not in every cell of the body. These mutations can change and evolve over time. Somatic mutations cannot be passed down from parent to children. Target therapies are available to patients with a genetic mutation identified by either germline or somatic testing.


Genomic Testing: What is Genomic Testing?

Genomic testing is done on cancerous tissue taken from the prostate in order to provide information about how your prostate cancer might behave. By looking at the genetic makeup of the cancer, these tests may help predict whether your prostate cancer grows slowly or aggressively. Genomic testing can be performed on both biopsy tissue and on tissue from an entire prostate following a prostatectomy. Click here to print or download a helpful PDF on genomic testing in relation to prostate cancer.

Who Should Get a Genomic Test?

These tests are useful for helping men and their physicians decide on a strategy for managing treatment, so they are often most helpful for men newly diagnosed with prostate cancer that is still confined to the prostate. However, men who have had surgery and want to understand their risk of a five-year recurrence may also find certain tests helpful.

Determining who needs treatment for prostate cancer has evolved with new options to diagnose aggressive vs. indolent disease. Check out our infographic with more information on what genomic and advanced tests are available based on a man’s individual cancer.

Watch Dr. Lowentritt of Chesapeake Urology discuss genomic testing for prostate cancer in the video below:

What Can Genomic Testing Tell Me?

 

In early-stage or localized prostate cancer, where the cancer is still confined to the prostate, there are three types of risk categories:

  • Low-risk prostate cancers that are unlikely to grow or spread for many years
  • Medium/intermediate-risk prostate cancers that are unlikely to grow or spread for a few years
  • High-risk prostate cancers that may grow or spread within a few years

Genomic testing can help men find out their risk category, and therefore which treatment options are available to them.


Genomic Testing and Demystifying Your Diagnosis

After a prostate cancer diagnosis, trying to understand all the treatment options available can be mind-boggling. An unclear path forward can leave men susceptible to both over-treatment, with all the unnecessary side effects, or under-treatment, which leaves the risk that the cancer will continue to grow. In many cases, genomic testing can help. This webinar, featuring speakers Dr. Kelvin Moses from Vanderbilt Cancer Center and Monica Bryant from Triage Cancer, will help men newly diagnosed with prostate cancer understand when, why, and how to receive genomic testing. This webinar took place on Monday, May 16th, at 4 pm EST. Find the recording here.

Click here to access the full slide deck of our previous webinar, Beyond the PSA: Genomic Testing and Localized Prostate Cancer

Click here to access our previously recorded webinar, Understanding Prostate Cancer in the Age of Personalized Medicine featuring Dr. Michael Brawer.


How Can I get a Genomic Test?

It’s important to talk to your doctor to find out if you are a candidate for a genomic test. There are several tests available today. Current tests include:

  • Oncotype Dx:
    • This test looks at the activity of certain genes in the prostate tumor and assigns a personalized result, called the Genomic Prostate Score, to each case. This number predicts the chance that the disease will be more aggressive and spread to other parts of the body if left untreated. This is used after a confirmed prostate cancer diagnosis of low-risk disease and uses biopsy tissue to predict the likelihood of future growth and spread. It is helpful for those considering active surveillance.
  • ProstaVysion:
    • This test looks at a sequence of certain genes and provides a personalized genetic panel to determine aggressiveness. This is used after a confirmed prostate cancer diagnosis and uses biopsy tissue to predict the likelihood of future growth and spread. It is helpful for those considering active surveillance.
  • Prolaris Test:
    • The Prolaris test measures how fast your cancer cells are dividing to predict aggressiveness. This is used after a confirmed prostate cancer diagnosis of low-risk disease and can use both biopsy tissue and tissue from radical prostatectomy to predict the likelihood of metastasis, biochemical recurrence, and death from prostate cancer. It is helpful for men deciding on a treatment option or trying to decide on additional treatment after surgery.
  • Decipher:
    • Decipher Biopsy is available for patients diagnosed with localized prostate cancer at the time of biopsy. Decipher Biopsy can help men and their doctors determine if it may be safe to consider active surveillance, treatment, or a combination of therapies. No additional procedure for the patient is needed to run this test.
    • Decipher Post-Op predicts the likelihood of prostate cancer metastasis for men with adverse pathology after radical prostatectomy. The test can help patients and their doctors decide if additional treatment is needed after surgery. Decipher Post-Op uses a tissue sample that was removed during surgery, so no additional procedure for the patient is needed.

What Are Genomics?Genetics-vs-Genomic

Genomics is the study of all the genes in the genome and their interactions with the environment. This is related to but not the same as genetics, the study of individual genes and inherited traits from one generation to the next.

The study of genetics in prostate cancer is important because family predisposition may be responsible for 5-10% of all prostate cancers1. A family history increases a man’s risk for prostate cancer by 60%.

Genomics in prostate cancer looks at how certain sets of genes in the prostate cancer tumor interact and function. The activity of these genes can then influence the behavior of the tumor, including how rapidly it is likely to grow and spread.

Bryce Olson, a 45-year-old husband, and father of a young daughter was recently diagnosed with stage 4 metastatic prostate cancer. Hear how he is staying ahead of his cancer by finding the genetic factors that fuel it through the new world of personalized, molecular treatment.

[1] http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf