Why ‘Genetic Testing is Critical’ in Patients with Prostate Cancer

For patients with prostate cancer, genetic testing can be crucial, as one expert recently noted.

“We know that prostate cancer has a strong genetic association, and for patients with prostate cancer, genetic testing is critical,” said Dr. Kristen R. Scarpato, an associate professor and the director of the Urology Residency Program and vice chair of education for the Department of Urology at Vanderbilt University Medical Center in Tennessee. “And that's across the continuum of prostate cancer, not just for patients who have advanced prostate cancer, but now even for patients who have localized prostate cancer with certain features genetic testing is really important. So it’s definitely something you should talk to your urologist about.”

Scarpato’s remarks were delivered during her talk at the CURE® Educated Patient® Prostate Cancer Summit.

Types of genetic testing, Scarpato explained, include germline testing, which tests the DNA that a patient inherits from their parents and passes on to their children, and somatic testing of DNA found only in tumor tissue.

Guidelines from the American Urologic Association with the Society of Urologic Oncology and other societies indicate that germline testing should be performed for all patients with prostate cancer because, as Scarpato said, “this can impact and inform prognosis, and then family members can be impacted. And then, importantly, it can open the door to potential targeted therapies or personalized medicine for patients.”

Such therapies include PARP inhibitors, a relatively new option for patients with advanced prostate cancer. PARP inhibitors, Scarpato explained, prevent the natural cell repair function of mutated cancer cells from functioning. In turn, she said, “the cancer cells die, which is what we want.”

As Scarpato detailed during her talk at the summit, the Food and Drug Administration (FDA) has approved a number of biomarker-targeted therapies for patients with advanced prostate cancer, including both monotherapies and combinations of PARP inhibitors and androgen receptor pathway inhibitors.

Recent FDA approvals have included Rubraca (rucaparib), which was approved in 2020 for patients with metastatic castration-resistant prostate cancer that expresses a BRCA mutation, and Lynparza (olaparib) plus abiraterone, which was approved in 2023 for with patients with deleterious or suspected deleterious BRCA-mutated metastatic castration-resistant prostate cancer.

Also in 2023, Akeega (niraparib plus abieraterone) with prednisone was approved for the treatment of deleterious or suspected deleterious BRCA-positive metastatic castration-resistant prostate cancer, and Talzenna (talazoparib) plus Xtandi (enzalutamide) was approved to treat homologous recombination repair (HRR) gene-mutated metastatic castration-resistant prostate cancer.

More recent data, Scarpato said, has importantly shown that approximately one in four patients who have metastatic castration-resistant prostate cancer will have this type of genetic mutation.

“So these patients, when you have genetic testing and have this mutation identified, these are the patients who benefit most from these targeted therapies with PARP inhibitors,” she said.

Scarpato expressed enthusiasm for the future of treatment developments for patients with prostate cancer.

“There's a lot of development, a lot of excitement, and a lot more therapies coming down the pike for patients with prostate cancer. … It is exciting to be in a place where we have so many options available and we're able to personalize management of patients with prostate cancer and PARP inhibitors represent just one way that we are able to now do that,” Scarpato said.

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