Germline and Somatic Genomic Testing for Metastatic Prostate Cancer: ASCO Guideline

Evan Y Yu ¹, R Bryan Rumble ², Neeraj Agarwal ³

¹University of Washington and Fred Hutchinson Cancer Center, Seattle, WA.
²American Society of Clinical Oncology, Alexandria, VA.
³Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT.
⁴University of Chicago, Chicago, IL.
⁵Duke Cancer Institute, Durham, NC.
⁶Dana Farber Cancer Institute, Boston, MA.
⁷Yale School of Medicine and Yale Cancer Center, New Haven, CT.
⁸UH Cleveland Medical Center, Cleveland, OH.
⁹UM/Sylvester Comprehensive Cancer Center, Miami, FL.
¹⁰Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung City, Taiwan.
¹¹Patient Representative, Chapter President UsTOO Las Vegas, Prostate Cancer Education and Support, Las Vegas, NV.
¹²Jefferson Einstein Medical Center, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA.

⁰University of Washington and Fred Hutchinson Cancer Center, Seattle, WA.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology +

|

January 9, 2025

View abstract on PubMed

Summary

Genomic testing for metastatic prostate cancer is recommended for all patients. Both germline and somatic DNA sequencing can guide treatment, including PARP inhibitors, and inform family screening.

Area Of Science

Genomic Medicine
Oncology
Prostate Cancer Research

Background

Metastatic prostate cancer management requires precise genomic profiling.
Germline and somatic mutations play critical roles in disease progression and treatment response.

Purpose Of The Study

To evaluate evidence on germline and somatic genomic testing in metastatic prostate cancer.
To provide evidence-based recommendations for clinical practice.

Main Methods

Systematic review of literature from January 2018 to May 2024.
Inclusion of studies reporting on genomic testing, detection rates, prognostic, and treatment implications.
Multidisciplinary panel with patient representation.

Main Results

1,713 papers were identified, with 14 meeting eligibility criteria (8 systematic reviews, 6 clinical trials).
Genomic testing guides poly(ADP-ribose) polymerase inhibitor use in metastatic castration-resistant prostate cancer.
Germline testing has implications for additional cancer screening and family cascade testing.

Conclusions

All patients with metastatic prostate cancer should undergo germline and somatic DNA sequencing.
Consider repeat testing if initial results are negative or uninformative.
Utilize metastatic biopsy or circulating tumor DNA (ctDNA) for retesting.
Prognostic-only genomic findings should not guide treatment outside clinical trials.