Germline Testing for Prostate Cancer Active Surveillance

Brian T. Helfand, MD, PhD, Chief of the Division of Urology and the Ronald L. Chez Family and Richard Melman Family Endowed Chair at NorthShore University HealthSystem, discusses the results of several germline testing studies and what they reveal about genetic mutation and their impact on the applicability of active surveillance for prostate cancer patients. He stresses the importance of establishing which gene mutations specifically lead to more aggressive and higher grade disease, finding that patients with ATM, BRCA1/2, and MSH2 consistently had more aggressive and higher grade cancer than those with ATM alone. Dr. Helfand then reviews a study of patients with ATM, BRCA1/2, MSH2, and CHEK2 mutations undergoing active surveillance. The study found that those patients were more often recategorized to higher grade cancer, and also more likely to die from prostate cancer, revealing that active surveillance is often not ideal in this patient population.