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

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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.

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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.