Previous Page  7 / 10 Next Page
Information
Show Menu
Previous Page 7 / 10 Next Page
Page Background

© The Canadian Journal of Urology™; 23(2); April 2016

Giri ET AL.

8251

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