Addressing Challenges and Controversies in the Management of Prostate Cancer with Multidisciplinary Teams

Shore, Neal D.; Morgans, Alicia K.; El-Haddad, Ghassan; Srinivas, Sandy; Abramowitz, Matthew C.

doi:10.1007/s11523-022-00925-7

Cited by 21 publications

(11 citation statements)

References 87 publications

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“…The application of these results necessitates comprehensive patient and familial counseling and a careful examination of potential clinical trial enrollment within and outside the institution. Therefore, a multidisciplinary approach is warranted, encompassing not only urologists but also hematologists, pathologists, laboratory medicine physicians, and genetic counselors involved in patient care [5,82]. This holistic approach promises to propel the field of urological oncology forward, improving patient outcomes through personalized care strategies.…”

Section: Discussionmentioning

confidence: 99%

Genetic Testing for Prostate Cancer, Urothelial Cancer, and Kidney Cancer

Han¹,

Kang²,

Byun³

et al. 2023

J Urol Oncol

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As genetic testing plays an increasingly salient role in the realm of cancer diagnosis, prognostication, and treatment, this review aims to elucidate the current landscape and future directions of genetic testing in genitourinary cancers, with a focus on prostate cancer, urothelial carcinoma, and renal cell carcinoma. With the increasing adoption of next-generation sequencing technology, the utilization and access to genetic testing in real-world settings have become critical for practicing urologists and genitourinary oncologists, especially after the approval of poly(ADP-ribose) polymerase inhibitors for prostate cancer and the utilization of immune checkpoint inhibitors. In this rapidly evolving field, this review underscores the clinical value of interpreting genetic variations and the importance of distinguishing between germline and somatic mutations, for whom testing can be prescribed, and which genes should be tested. While the current modus operandi predominantly relies on exome sequencing, we posit that the future of genetic testing in genitourinary cancers will see an expansion to encompass whole-genome sequencing, accounting for structural and regulatory variations that impact gene expression. In the upcoming era of liquid biopsies, we envisage an increase in noninvasive cancer genetic testing for the purposes of diagnosis, prognosis, treatment response, and progression monitoring, supplementing the gold-standard tissue biopsies that provide histologic information. Ultimately, thoroughly interpreting genetic testing results and the subsequent treatment implications necessitates a multidisciplinary approach. This review strives to offer urologists a comprehensive perspective on genetic testing in these prevalent urological cancers, contributing to improved diagnosis, prognosis, and treatment decision-making.

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Section: Discussionmentioning

confidence: 99%

Genetic Testing for Prostate Cancer, Urothelial Cancer, and Kidney Cancer

Han¹,

Kang²,

Byun³

et al. 2023

J Urol Oncol

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“…The implementation of rapid advances in the personalized management of prostate cancer comes with challenges. Shore et al emphasized the value of multidisciplinary teams to overcome these difficulties [ 19 ]. These teams will be essential in navigating the controversies related to the diagnosis, treatment, and monitoring of prostate cancer.…”

Section: Challenges In Genetic Counseling and Germline Genetic Testin...mentioning

confidence: 99%

Germline Mutations and Ancestry in Prostate Cancer

Bataba,

Babcock,

Isensee

et al. 2024

Curr Oncol Rep

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Purpose of Review Prostate cancer is the most frequently diagnosed non-cutaneous malignancy of men in the USA; notably, the incidence is higher among men of African, followed by European and Asian ancestry. Germline mutations and, in particular, mutations in DNA damage repair genes (DDRGs) have been implicated in the pathogenesis of prostate cancer. This review intends to discuss the implication of ancestry on prostate cancer, specifically in regard to lack of diversity in genomic and genetic databases and the ability of providers to properly counsel patients on the significance of cancer genetic results. Recent Findings Ancestral differences in prostate cancer-associated DDRG germline mutations are increasingly recognized. Guidelines for treatment by the National Comprehensive Cancer Network® (NCCN®) support germline testing in certain patients, and a myriad of genetic testing panels for DDRG mutations are now available in clinical practice. However, the consensus among providers on what genes and mutations to include in the genetic tests has evolved from experience from men of European ancestry (EA). Gaps in ancestry-informed clinical practice exist in genetic risk assessment, implementation of screening, counseling, guiding recommendations, treatment, and clinical trial enrollment. Summary The lack of diversity in tumor genomic and genetic databases may hinder ancestry-specific disease-predisposing alterations from being discovered and targeted in prostate cancer and, therefore, impede the ability of providers to accurately counsel patients on the significance of cancer genetic test results.

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“…The decision to proceed with 177 LuPSMA radioligand therapy involves a thorough evaluation by an MDT, con sidering not only the PSMA PET imaging results but also the patient's overall health, prior treatments, and the potential for response based on PSMA expression levels [5]. This MDT approach ensures that all aspects of the patient's condition are considered, allowing for personalized treatment plan ning.…”

Section: Patient Selection For Psma Radioligand Therapymentioning

confidence: 99%

Multidisciplinary Team Approach in Prostate-Specific Membrane Antigen Theranostics for Prostate Cancer: A Narrative Review

Suh,

Cheon

2024

J Urol Oncol

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In managing prostate cancer, the integration of multidisciplinary team (MDT) with prostate-specific membrane antigen (PSMA) theranostics marks a significant advancement, addressing the disease's spectrum from indolent forms to aggressive metastatic stages. MDTs, comprising urology, oncology, radiation oncology, pathology, radiology, and nuclear medicine experts, are pivotal in delivering tailored, evidence-based care, essential for the varied clinical presentations of prostate cancer. The introduction of PSMA-targeted theranostics and PSMA positron emission tomography imaging has impacted the approach to diagnosis and treatment, offering enhanced precision in disease localization and enabling more nuanced management strategies for conditions such as oligometastatic prostate cancer, metastatic hormone-sensitive prostate cancer, and metastatic castration-resistant prostate cancer. The collaborative approach of MDTs in utilizing PSMA-targeted radioligand therapy emphasizes meticulous patient selection, predictive assessment of therapy response, and careful management of therapy-related toxicities. Additionally, recent strategies, including combination therapies from ENZA-P and Lu-PARP trials, show potential for improving treatment efficacy. This unified approach showcases the critical role of MDTs in optimizing treatment outcomes, underscoring the importance of collaboration in advancing the treatment of prostate cancer with PSMAtargeted therapies, thereby setting a new paradigm in personalized prostate cancer management.

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Addressing Challenges and Controversies in the Management of Prostate Cancer with Multidisciplinary Teams

Cited by 21 publications

References 87 publications

Genetic Testing for Prostate Cancer, Urothelial Cancer, and Kidney Cancer

Genetic Testing for Prostate Cancer, Urothelial Cancer, and Kidney Cancer

Germline Mutations and Ancestry in Prostate Cancer

Multidisciplinary Team Approach in Prostate-Specific Membrane Antigen Theranostics for Prostate Cancer: A Narrative Review

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