Role of Genetic Testing for Inherited Prostate Cancer Risk: Philadelphia Prostate Cancer Consensus Conference 2017
Authors: Giri Veda N. , Knudsen Karen E. , Kelly William K. , Abida Wassim , Andriole Gerald L. , Bangma Chris H. , Bekelman Justin E. , Benson Mitchell C. , Blanco Amie , Burnett Arthur , Catalona William J. , Cooney Kathleen A. , Cooperberg Matthew , Crawford David E. , Den Robert B. , Dicker Adam P. , Eggener Scott , Fleshner Neil , Freedman Matthew L. , Hamdy Freddie C. , Hoffman-Censits Jean , Hurwitz Mark D. , Hyatt Colette , Isaacs William B. , Kane Christopher J. , Kantoff Philip , Karnes R. Jeffrey , Karsh Lawrence I. , Klein Eric A. , Lin Daniel W. , Loughlin Kevin R. , Lu-Yao Grace , Malkowicz S. Bruce , Mann Mark J. , Mark James R. , McCue Peter A. , Miner Martin M. , Morgan Todd , Moul Judd W. , Myers Ronald E. , Nielsen Sarah M. , Obeid Elias , Pavlovich Christian P. , Peiper Stephen C. , Penson David F. , Petrylak Daniel , Pettaway Curtis A. , Pilarski Robert , Pinto Peter A. , Poage Wendy , Raj Ganesh V. , Rebbeck Timothy R. , Robson Mark E. , Rosenberg Matt T. , Sandler Howard , Sartor Oliver , Schaeffer Edward , Schwartz Gordon F. , Shahin Mark S. , Shore Neal D. , Shuch Brian , Soule Howard R. , Tomlins Scott A. , Trabulsi Edouard J. , Uzzo Robert , Vander Griend Donald J. , Walsh Patrick C. , Weil Carol J. , Wender Richard , Gomella Leonard G. 
Published: December 2017

Purpose

Guidelines are limited for genetic testing for prostate cancer (PCA). The goal of this conference was to develop an expert consensus-driven working framework for comprehensive genetic evaluation of inherited PCA in the multigene testing era addressing genetic counseling, testing, and genetically informed management.

Methods

An expert consensus conference was convened including key stakeholders to address genetic counseling and testing, PCA screening, and management informed by evidence review.

Results

Consensus was strong that patients should engage in shared decision making for genetic testing. There was strong consensus to test HOXB13 for suspected hereditary PCA, BRCA1/2 for suspected hereditary breast and ovarian cancer, and DNA mismatch repair genes for suspected Lynch syndrome. There was strong consensus to factor BRCA2 mutations into PCA screening discussions. BRCA2 achieved moderate consensus for factoring into early-stage management discussion, with stronger consensus in high-risk/advanced and metastatic setting. Agreement was moderate to test all men with metastatic castration-resistant PCA, regardless of family history, with stronger agreement to test BRCA1/2 and moderate agreement to test ATM to inform prognosis and targeted therapy.

Conclusion

To our knowledge, this is the first comprehensive, multidisciplinary consensus statement to address a genetic evaluation framework for inherited PCA in the multigene testing era. Future research should focus on developing a working definition of familial PCA for clinical genetic testing, expanding understanding of genetic contribution to aggressive PCA, exploring clinical use of genetic testing for PCA management, genetic testing of African American males, and addressing the value framework of genetic evaluation and testing men at risk for PCA—a clinically heterogeneous disease.