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Giri VN , Knudsen KE , Kelly WK , Cheng HH , Cooney KA , Cookson MS , Dahut W , Weissman S , Soule HR , Petrylak DP , Dicker AP , AlDubayan SH , Toland AE , Pritchard CC , Pettaway CA , Daly MB , Mohler JL , Parsons JK , Carroll PR , Pilarski R , Blanco A , Woodson A , Rahm A , Taplin ME , Polascik TJ , Helfand BT , Hyatt C , Morgans AK , Feng F , Mullane M , Powers J , Concepcion R , Lin DW , Wender R , Mark JR , Costello A , Burnett AL , Sartor O , Isaacs WB , Xu J , Weitzel J , Andriole GL , Beltran H , Briganti A , Byrne L , Calvaresi A , Chandrasekar T , Chen DYT , Den RB , Dobi A , Crawford ED , Eastham J , Eggener S , Freedman ML , Garnick M , Gomella PT , Handley N , Hurwitz MD , Izes J , Karnes RJ , Lallas C , Languino L , Loeb S , Lopez AM , Loughlin KR , Lu-Yao G , Malkowicz SB , Mann M , Mille P , Miner MM , Morgan T , Moreno J , Mucci L , Myers RE , Nielsen SM , O'Neil B , Pinover W , Pinto P , Poage W , Raj GV , Rebbeck TR , Ryan C , Sandler H , Schiewer M , Scott EMD , Szymaniak B , Tester W , Trabulsi EJ , Vapiwala N , Yu EY , Zeigler-Johnson C , Gomella LG
Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019
J Clin Oncol. 2020 Aug 20 ;38(24) :2798-2811
PMID: 32516092    PMCID: PMC7430215    URL: https://www.ncbi.nlm.nih.gov/pubmed/32516092
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Abstract
PURPOSE: Germline testing (GT) is a central feature of prostate cancer (PCA) treatment, management, and hereditary cancer assessment. Critical needs include optimized multigene testing strategies that incorporate evolving genetic data, consistency in GT indications and management, and alternate genetic evaluation models that address the rising demand for genetic services. METHODS: A multidisciplinary consensus conference that included experts, stakeholders, and national organization leaders was convened in response to current practice challenges and to develop a genetic implementation framework. Evidence review informed questions using the modified Delphi model. The final framework included criteria with strong (> 75%) agreement (Recommend) or moderate (50% to 74%) agreement (Consider). RESULTS: Large germline panels and somatic testing were recommended for metastatic PCA. Reflex testing-initial testing of priority genes followed by expanded testing-was suggested for multiple scenarios. Metastatic disease or family history suggestive of hereditary PCA was recommended for GT. Additional family history and pathologic criteria garnered moderate consensus. Priority genes to test for metastatic disease treatment included BRCA2, BRCA1, and mismatch repair genes, with broader testing, such as ATM, for clinical trial eligibility. BRCA2 was recommended for active surveillance discussions. Screening starting at age 40 years or 10 years before the youngest PCA diagnosis in a family was recommended for BRCA2 carriers, with consideration in HOXB13, BRCA1, ATM, and mismatch repair carriers. Collaborative (point-of-care) evaluation models between health care and genetic providers was endorsed to address the genetic counseling shortage. The genetic evaluation framework included optimal pretest informed consent, post-test discussion, cascade testing, and technology-based approaches. CONCLUSION: This multidisciplinary, consensus-driven PCA genetic implementation framework provides novel guidance to clinicians and patients tailored to the precision era. Multiple research, education, and policy needs remain of importance.
Notes
1527-7755 Giri, Veda N Knudsen, Karen E Kelly, William K Cheng, Heather H Cooney, Kathleen A Cookson, Michael S Dahut, William Weissman, Scott Soule, Howard R Petrylak, Daniel P Dicker, Adam P AlDubayan, Saud H Toland, Amanda E Pritchard, Colin C Pettaway, Curtis A Daly, Mary B Mohler, James L Parsons, J Kellogg Carroll, Peter R Pilarski, Robert Blanco, Amie Woodson, Ashley Rahm, Alanna Taplin, Mary-Ellen Polascik, Thomas J Helfand, Brian T Hyatt, Colette Morgans, Alicia K Feng, Felix Mullane, Michael Powers, Jacqueline Concepcion, Raoul Lin, Daniel W Wender, Richard Mark, James Ryan Costello, Anthony Burnett, Arthur L Sartor, Oliver Isaacs, William B Xu, Jianfeng Weitzel, Jeffrey Andriole, Gerald L Beltran, Himisha Briganti, Alberto Byrne, Lindsey Calvaresi, Anne Chandrasekar, Thenappan Chen, David Y T Den, Robert B Dobi, Albert Crawford, E David Eastham, James Eggener, Scott Freedman, Matthew L Garnick, Marc Gomella, Patrick T Handley, Nathan Hurwitz, Mark D Izes, Joseph Karnes, R Jeffrey Lallas, Costas Languino, Lucia Loeb, Stacy Lopez, Ana Maria Loughlin, Kevin R Lu-Yao, Grace Malkowicz, S Bruce Mann, Mark Mille, Patrick Miner, Martin M Morgan, Todd Moreno, Jose Mucci, Lorelei Myers, Ronald E Nielsen, Sarah M O'Neil, Brock Pinover, Wayne Pinto, Peter Poage, Wendy Raj, Ganesh V Rebbeck, Timothy R Ryan, Charles Sandler, Howard Schiewer, Matthew Scott, E Michael D Szymaniak, Brittany Tester, William Trabulsi, Edouard J Vapiwala, Neha Yu, Evan Y Zeigler-Johnson, Charnita Gomella, Leonard G Journal Article United States J Clin Oncol. 2020 Jun 9:JCO2000046. doi: 10.1200/JCO.20.00046.