ASCO Releases New Recommendations on Germline and Somatic Testing for Metastatic PCa

New recommendations released by the American Society of Clinical Oncology (ASCO) have provided updates to guidelines on the use of germline and somatic genomic testing for patients with metastatic prostate cancer (PCa).

A systematic review utilized articles from the PubMed database that were searched from January 2018 to May 2024. The review involved a multidisciplinary panel with patient representation.

Articles were included in the review if they reported on patients with metastatic PCa who received a germline or somatic genomic test and/or made comparisons between those tests, reported detection rates, prognostic information, or treatment implications.

Overall, a total of 1,713 articles were found. After eligibility criteria were applied, eight systematic reviews and six clinical trials remained and were used to guide the new recommendations.

Patients with metastatic PCa are recommended to undergo both germline and somatic DNA sequencing using panel-based assays because these tests can guide the use of poly(ADP-ribose) polymerase inhibitors, which have a survival benefit for patients with metastatic castration-resistant PCa. Germline testing can also aid in the detection of additional cancers and can have testing implications for family members.

New data are more limited on when to carry out repeat testing and optimal tissue type (eg, primary tumor vs metastatic biopsy vs circulating tumor DNA [ctDNA] testing). However, the ASCO Guidelines panel recommends considering retesting for patients with results that have previously been negative or uninformative and considering a metastatic biopsy or ctDNA testing when a significant change in clinical status occurs.

When guiding treatment outside of a clinical trial, next-generation genomic sequencing findings that are associated with predictive, not prognostic, value should be used. Additional guideline information can be found on the ASCO website.