Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019


Veda N. Giri, Sidney Kimmel Cancer Center at Jefferson
Karen E. Knudsen, Sidney Kimmel Cancer Center at Jefferson
William K. Kelly, Sidney Kimmel Cancer Center at Jefferson
Heather H. Cheng, University of Washington, Seattle
Kathleen A. Cooney, Duke University School of Medicine
Michael S. Cookson, University of Oklahoma
William Dahut, National Cancer Institute (NCI)
Scott Weissman, National Society of Genetic Counselors
Howard R. Soule, Prostate Cancer Foundation
Daniel P. Petrylak, Yale Cancer Center
Adam P. Dicker, Sidney Kimmel Cancer Center at Jefferson
Saud H. AlDubayan, Dana-Farber Cancer Institute
Amanda E. Toland, The Ohio State University Comprehensive Cancer Center
Colin C. Pritchard, University of Washington, Seattle
Curtis A. Pettaway, University of Texas MD Anderson Cancer Center
Mary B. Daly, Fox Chase Cancer Center
James L. Mohler, Roswell Park Cancer Institute
J. Kellogg Parsons, University of California, San Diego
Peter R. Carroll, University of California, San Francisco
Robert Pilarski, The Ohio State University Comprehensive Cancer Center
Amie Blanco, University of California, San Francisco
Ashley Woodson, University of Texas MD Anderson Cancer Center
Alanna Rahm, Genomic Medicine Institute
Mary Ellen Taplin, Dana-Farber Cancer Institute
Thomas J. Polascik, Duke University Medical Center
Brian T. Helfand, NorthShore University HealthSystem
Colette Hyatt, Sidney Kimmel Cancer Center at Jefferson
Alicia K. Morgans, Northwestern University
Felix Feng, University of California, San Francisco
Michael Mullane, Advocate Aurora Health
Jacqueline Powers, University of Pennsylvania
Raoul Concepcion, Integra Connect
Daniel W. Lin, University of Washington, Seattle

Document Type

Journal Article

Publication Date



Journal of Clinical Oncology








© 2020 by American Society of Clinical Oncology 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.

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