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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Enzalutamide significantly reduced risk of prostate cancer progression or death compared with bicalutamide in patients with nonmetastatic or metastatic CRPC.

BACKGROUND: PROCEED (), a large registry, evaluated sipuleucel-T immunotherapy for asymptomatic/minimally symptomatic metastatic castration-resistant prostate cancer (mCRPC). METHODS: PROCEED enrolled mCRPC patients receiving three biweekly sipuleucel-T infusions. Assessments included: overall survival (OS); serious adverse events (SAEs); cerebrovascular events (CVEs); and anticancer interventions (ACIs). Follow-up was ≥3 years, until death, or study withdrawal. RESULTS: 1976 patients (2011–2017) were followed for 46.6 months (median). Median age was 72 years and baseline median prostate-specific antigen was 15.0 ng/ml. 86.7% were Caucasians and 11.6% African American. 1902 patients had ≥1 sipuleucel-T infusion. Median OS was 30.7 (95% confidence interval [CI]: 28.6–32.2) months. Known prognostic factors were independently associated with OS on multivariable analysis. 1255 patients died, 964 (76.8%) from prostate cancer (PC) progression. Median time from first infusion to PC death was 42.7 (95% CI: 39.4–46.2) months. Incidence of sipuleucel-T-related SAEs was 3.9%. Incidence of CVEs was 2.8% and the rate per 100 person-years was 1.2 (95% CI: 0.9–1.6). CVE incidence among 11,972 mCRPC patients from the SEER-Medicare database was 2.8%; 1.5 [95% CI 1.4–1.7]/100 person-years. 77.7% of patients received ≥1 ACI (abiraterone, enzalutamide, docetaxel, cabazitaxel, or radium-223) after sipuleucel-T; 32.5% and 17.4% of patients experienced a 1- and 2-year treatment-free interval, respectively. CONCLUSIONS: PROCEED provides contemporary survival data for sipuleucel-T-treated men in a real-world setting of new life-prolonging agents, which will be useful in discussing treatment options with patients and in powering future trials with sipuleucel-T. Safety and tolerability of sipuleucel-T in PROCEED was consistent with previous findings.

Increasing prostate volume contributes to urinary tract symptoms and may obscure prostate cancer detection. We investigated the association between obesity and prostate volume, prostate-specific antigen (PSA) and PSA density among 753 men referred for prostate biopsy. Among men with a negative biopsy, prostate volume significantly increased approximately 25% from the lowest to highest body mass index (BMI), waist or hip circumference or height categories. PSA was 0.7 ng/ml lower with a high waist-to-hip ratio. These associations were less consistent among subjects diagnosed with high-grade prostatic intraepithelial neoplasia or cancer. Our data suggest that obesity and height are independently associated with prostate volume.