Gomella Discusses Ongoing Progress With Genetic Testing in Prostate Cancer

Leonard G. Gomella, MD

There is much room for advancement in both the basic science and clinical implementation of genetic testing for inherited prostate cancer, says Leonard Gomella, MD

“We hope that our consensus meeting that we're having now will help contribute to the understanding of how to best do genetic testing in men with possibly inherited prostate cancer risk,” Gomella said at the 2017 Philadelphia Prostate Cancer International Consensus, which was recently held at the Sidney Kimmel Cancer Center of Thomas Jefferson University.

In an interview with OncLive at the consensus, Gomella, professor, chair, Department of Urology, director, Kimmel Cancer Center Network, Thomas Jefferson University, discussed the current state and critical next steps for optimizing genetic testing in prostate cancer.

OncLive: Please highlight some of the talks that are being presented at this meeting.

Gomella: I think we have a spectrum of talks at this meeting that are interesting. There are basic science genetic talks, but I think some of the better talks are ones that discuss general clinical concepts about how we use genetic testing today in a variety of cancers. It is very common in breast and ovarian cancer, so that's the model, but we're starting to get more involved in instructing physicians on how to best council patients about prostate cancer. In my opinion, as a clinician, the most practical ones right now are helping guide patients to or away from genetic testing for prostate cancer.

What advancements are being made in prostate cancer that you are particularly excited about?

Ever since the human genome project was completed back in 2006, there has been an explosion in genetic and genomic research. The important thing going on right now is further discovery of the genes that are involved with inherited prostate cancer. We already know a couple of them, but there are many thousands of genes out there. I think there is exciting work being done by some of the leaders who are participating in this meeting who are doing the basic science research to figure out which are the important genes in prostate cancer and which are the ones that don't have any relevance.

What are some ongoing trials that you are excited to see the results of?

In addition to our work that is being done here, there are several dozen other trials that we're reviewing at this meeting that are being done in the United States and around the world, trying to answer the questions about inherited prostate cancer genetic testing.

What are some of the other challenges facing the field of prostate cancer that you would like to see addressed in the next 5 to 10 years?

We have a lot of problems with paying for these genetic tests right now. That is a big problem. Also, whether or not insurance companies will pay often depends upon how many risk factors an individual may have. There are some insurance companies that are not covering any genetic testing for men. That is something that we have to address.

The other thing that we just have to do as the understanding of the genetics of prostate cancer grow, is making sure that our primary care colleagues and our other colleagues who work in urological oncology in prostate cancer, such as radiation oncology, medical oncology, and family medicine, begin to understand the proper roles, techniques, and tests to get for patients with prostate cancer. These are things we are working out in the next 3 to 5 years. Again, we hope that our consensus meeting that we're having now will help contribute to the understanding of how to best do genetic testing in men with possibly inherited prostate cancer risk.

What are some of the key takeaways you would like community oncologists to learn consensus?

The things we'd like everyone to take away from this meeting is the fact that progress has been made, particularly over the last 1 to 2 years, in the area of genetic testing for prostate cancer. There are many commercial panels that are now being offered that can be used but one of the cautions that we give is that just ordering a genetic test is not enough. We must rely on our trained and certified genetic counselors to help us as clinicians figure out this genetic testing.

Our belief is that when there is a concern about a potentially inherited cancer risk in many patients with prostate cancer that we send the patients to a genetic counsellor who then may make recommendations as to the appropriate genetic testing to perform. I don't think we're at the point yet where the average urologist, medical oncologist, or radiation oncologist is ordering these tests and knows how to interpret them. We really have to rely upon the expertise of genetic counsellors to put this all into context.

What impact does this genetic testing ultimately have on the patient?

The impact on an individual patient may be primarily in how aggressively they're followed up for recurrence once they have the cancer. If the cancer recurs, the follow-up might be directed towards one treatment over another based on their genetic test, but we look at this as something which is beyond the patient. It is really the rest of the family and trying to sort out and connect the dots between the potential for brothers or sons with prostate cancer or sisters or female children with breast and ovarian cancers. These are all the things we have to connect the dots on, beyond just prostate cancer in an individual.

We're involved with a couple of trials, one is looking at a 25-gene panel of patients who come into our multidisciplinary clinic. The aim of the study was trying to further identify other genes that we may not be that familiar with right now that are important.