Impact of Germline Genetic Testing for Men with Prostate Cancer on Active Surveillance
Abstract
Men with low-risk prostate cancer often defer immediate treatment in favor of active surveillance—close monitoring of their disease with blood tests and prostate biopsies—with surgery or radiation recommended only if there are signs of the cancer becoming more aggressive. Recent studies show that men with prostate cancer frequently have inherited mutations in genes involved in repairing DNA. Men who inherit these mutations are more likely to have aggressive prostate cancer compared to men without these mutations. If we find these mutations in men with low-risk prostate cancer who are on active surveillance, it might provide the opportunity to closely monitor these patients by implementing an alternative active surveillance schedule or referring men to surgery, radiation, or other curative treatments. Testing for inherited mutations, however, can also produce feelings of anxiety, depression, and worry. No studies have been conducted to evaluate the impact of testing for inherited mutations among men with low-risk prostate cancer on active surveillance. The primary objective of the proposed study is to evaluate whether genetic testing is acceptable to men with prostate cancer on active surveillance and whether having an inherited mutation has an impact on levels of anxiety or how patients make prostate cancer treatment decisions. We also want to know how frequent these mutations are in men on active surveillance and whether men with inherited mutations are at an increased risk of their cancer becoming more advanced. To answer these questions, we will conduct a clinical trial, recruiting 600 men with low-risk prostate cancer on active surveillance over 3 years. If our trial identifies a subset of men with low-risk prostate cancer who have inherited mutations that put them at higher risk of developing advanced disease and dying from it, we will be able to change how we treat men with low-risk disease, recommending more immediate treatment to increase their quality of life and longevity. If men with these mutations have poorer outcomes, our research may lay the foundation for genetic testing and counseling to be integrated into the treatment of men who are candidates for active surveillance. The men who will benefit the most from this research are those with low-risk cancer who are eligible for active surveillance. They may benefit from genetic testing and counseling and from considering alternative treatment options. Better understanding of their risk will help such men, along with their physicians, choose the best treatment plan for their individual disease. Upon successful completion of our research, we will likely choose to replicate our findings in a broader group of men treated at multiple institutions. We will be ready to undertake this research immediately following the proposed study. However, if our study shows that inherited mutations in DNA repair genes are common in men with low-risk prostate cancer and having a mutation increases the risk of developing advanced prostate cancer, the results from our study may be enough to change clinical practice. Since tests for these mutations are already available, it may quickly become standard practice for physicians to recommend genetic testing for men on active surveillance to help make the best recommendations about treatment. In the long term, future analyses of the genetic basis of aggressive cancers in men with low-risk disease may lead to greater understanding of key biological mechanisms that drive deadly prostate cancers. Such knowledge may provide important insights for the development of new treatments that could help a wide range of men with prostate cancer.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010135
Entities
People
- Maria I Carlo
Organizations
- Sloan-Kettering Institute
- United States Army