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

what was tested. The disclosure session is primarily

focused on cancer screening recommendations for the

prostate cancer patient based upon family history. For

example, if there is a strong family history of colon

cancer, the patient is recommended to consult with a

gastroenterologist formore frequent colonoscopies. The

disclosure session also encompasses cancer screening for

blood relatives. Unaffected first-degree male relatives

(particularly sons and brothers) are recommended to

have adiscussionof PSA-basedprostate cancer screening

starting at 40 based upon family history of prostate

cancer.

17

Additional cancer screening recommendations

for relatives (such as breast cancer or colon cancer

screening) are basedupon reported family cancer history,

suchas age tobeginscreeningand frequencyof screening,

as per existing guidelines.

5,18

Variant of uncertain significance (VUS)

Genetic test reports can also include variants of uncertain

significance in the genes tested. Current consensus in

the field is that management recommendations do not

change based upon identifying a VUS. The genetic

testing laboratory with experience in clinical testing will

follow these variants over time to gather more evidence

to determine if a reclassification is possible. Over time,

many of these VUSs are reclassified to pathogenic/

likely pathogenic (disease-associated) or benign. The

laboratories inform ordering doctors when a variant is

reclassified so that patients canbenotifiedof thepotential

need to return for additional disclosure discussions.

Therefore, it is essential toknowthevariant reclassification

policy of a commercial genetic testing laboratory, as well

as followuppolicywithorderingphysicians andpatients.

Conclusion

Though multiple genes are identified to contribute

to prostate cancer inheritance, guidelines are needed

regarding how best to incorporate genetic testing into

clinical practice. Our approach of offering genetic

counseling and focused clinical genetic testing opens

the door to addressing inherited cancer risk concerns

for prostate cancer patients and their families. Clinical

genetic testing studies, such as at our institution,

are beginning to identify a broader range of genetic

contribution to prostate cancer risk, which is expected

to inform interpretation of inherited predisposition and

cancer riskmanagement. All of these efforts point to the

need to develop the field of genetic testing for inherited

prostate cancer in order to providemore comprehensive

and informative genetic testing for prostate cancer

patients and their families to personalize cancer risk

reduction, screening, and treatment approaches.

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