© The Canadian Journal of Urology™; 23(2); April 2016
Giri ET AL.
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At this time, insurance coverage for genetic testing of
prostate cancer is challenging which limits the ability of
prostate cancer patients to have genetic testing covered.
One reason is that national guidelines are very focused
regardingwhichprostate cancer patientswarrant genetic
evaluation. Patients meeting criteria may have genetic
testing covered by some insurance plans. Multiple
commercial laboratories are options for patients to
performgenetic testing, includingMyriadGenetics, Inc.,
Ambry Genetics, GeneDx, and Invitae. However many
patients fall outside of genetic evaluation guidelines
and cannot have testing covered by insurance, though
the suspicion for inherited predisposition remains.
Therefore, clinical genetic investigational studies are
critical to expand the understanding of the genetic
spectrum of prostate cancer predisposition and gain
insights into clinical application. Such a clinical genetic
testing study is available to prostate cancer patients
meeting eligibility criteria at our institution. Figure 2
shows the clinical flowfor genetic evaluationof inherited
prostate cancer at our institution.
Referral criteria for providers
Referral criteria for prostate cancer patients for genetic
evaluation at our institution have been developed
after consensus by urologic oncology, medical
oncology, and radiation oncology providers. These
criteria take a broad approach in order to incorporate
the potential spectrum of patients who may have
suspected inherited prostate cancer. Referral criteria
for genetic evaluation include any of the following:
1) prostate cancer diagnosis at age ≤ 65, 2) Gleason
score > 7 and family history of cancers related toHBOC
(cancers of the breast, ovary, pancreas, or prostate),
or 3) family history of cancers relevant to HBOC,
HPC, or Lynch syndrome particularly in first-degree
or second-degree relatives given the implication of
prostate cancer in these syndromes (includes cancers
of the breast, ovary, pancreas, prostate, colon, uterus,
upper tract urothelial cancer, small bowel). Table 2
Figure 2.
Proposed clinical flow of genetic evaluation for inherit prostate cancer.
TABLE 2.
Referral criteria for prostate cancer patients
for genetic evaluation
Referral criteria
References
Age at prostate cancer diagnosis
13
≤ 65 years
Gleason score > 7 and family
5
history of cancers related to HBOC
Family history of cancers relevant
5, 8-11
to HBOC, HPC, or Lynch syndrome
particularly in first-degree or second-
degree relatives given the implication
of prostate cancer in these syndromes
HBOC = hereditary breast and ovarian cancer syndrome
HPC = hereditary prostate cancer