Guidelines on Germline Testing for Urologic Tumor Syndromes

Outcomes of a universal germline screening program in a community urology practice

The role of germline genetic testing in urologic oncology has expanded in recent years. However, implementation of genetic testing in community practices remains a challenge, often due to limited access to qualified genetics trained providers. In this study, we report outcomes of a universal germline screening program in a community urology practice. Between November 2021 and September 2022, all patients referred for urology clinic visits at Frederick Health (Frederick, MD, USA) were provided an online genetics screening questionnaire prior to the visit. Responses were compared against National Comprehensive Cancer Network (NCCN) criteria for germline testing. Those who met criteria were provided educational materials at the end of the questionnaire, and then counseled by a trained urologic oncologist (HC) in the clinic or referred to a genetic counselor prior to testing. Testing was performed with a 36-gene pan-cancer panel (CancerNext) or a 14-gene targeted prostate cancer panel (ProstateNext), with or without additional RNA analysis (RNAinsight) (Ambry Genetics, CA, USA). Demographic and clinical parameters, as well as genetic testing results, were retrospectively collected under IRB approval. In the study period, 765 patients were seen over 1370 clinic visits. Of these, 505 patients (66.0%) completed the screening questionnaire. The majority were completed via email (54.5%) with the remainder (45.5%) via text message. Of the patients who completed screening, 125/505 (24.7%) met NCCN criteria for germline testing. 58/125 patients (46.4%) who met criteria underwent germline testing, of whom 5/58 (8.6%) had distinct pathogenic mutations identified. These included actionable mutations in BRCA1, BRCA2, and CHEK2, as well as an additional pathogenic mutation in NBN. Variants of unknown significance were identified in 8/58 patients (13.8%) in 11 total genes. Challenges to implementation of this program included meeting institutional requirements for genetic testing consent, facilitating specimen collection in clinic, and integration of results into the electronic health record. Genetic risk assessment for high-risk individuals is feasible as part of a universal screening program in a community urology practice. Approximately 8% of tested patients were found to have pathogenic germline mutations, which is consistent with contemporary tertiary referral cohorts.

Advancements and prospects of Raman spectroscopy in urological tumors: a bibliometric analysis

Raman spectroscopy exhibits potential as a tool for identifying the chemical composition of substances and has witnessed a growing application in urological oncology. This study undertook a bibliometric analysis to chart the present state and future prospects of Raman spectroscopy applications in urological tumors. The present study retrieved literature on the utilization of Raman spectroscopy in urological oncology from the Science Citation Index Expanded of Web of Science Core Collection, spanning from its inception to June 2023. Data from included studies were analyzed using CiteSpace, Python, and Excel. Our study examined 897 articles from 65 countries and identified a significant exponential growth in annual publications. The USA and China were prominent contributors to this field, with high publication rates and funding agencies. Shanghai Jiao Tong University emerged as the most influential institution. The journals Analytical Chemistry and Analyst were found to be the most productive. Our keyword analysis revealed an intense interest for "gold nanoparticle" and "pathology," with the most recent bursts occurring for "surface-enhanced Raman scattering (SERS)," "biomarkers," and "prostate specific antigen." As a detection tool, Raman spectroscopy holds the potential to assist in the identification, management, and prognostication of urological tumors. Notably, adjuvant diagnosis and prognosis evaluation based on SERS of tumor markers is a hot research topic. These findings offer valuable insights into the current state of Raman spectroscopy research in urological oncology, which could inform future studies and clinical practice.

Efficacy of National Comprehensive Cancer Network Guidelines in Identifying Pathogenic Germline Variants Among Unselected Patients with Prostate Cancer: The PROCLAIM Trial

BACKGROUND

Prostate cancer (PCa) patients with pathogenic/likely pathogenic germline variants (PGVs) in cancer predisposition genes may be eligible for U.S. Food and Drug Administration-approved targeted therapies, clinical trials, or enhanced screening. Studies suggest that eligible patients are missing genetics-informed care due to restrictive testing criteria.

OBJECTIVE

To establish the prevalence of actionable PGVs among prospectively accrued, unselected PCa patients, stratified by their guideline eligibility.

DESIGN, SETTING, AND PARTICIPANTS

Consecutive, unselected PCa patients were enrolled at 15 sites in the USA from October 2019 to August 2021, and had multigene cancer panel testing.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Correlates between the prevalence of PGVs and clinician-reported demographic and clinical characteristics were examined.

RESULTS AND LIMITATIONS

Among 958 patients (median [quartiles] age at diagnosis 65 [60, 71] yr), 627 (65%) had low- or intermediate-risk disease (grade group 1, 2, or 3). A total of 77 PGVs in 17 genes were identified in 74 patients (7.7%, 95% confidence interval [CI] 6.2-9.6%). No significant difference was found in the prevalence of PGVs among patients who met the 2019 National Comprehensive Cancer Network Prostate criteria (8.8%, 43/486, 95% CI 6.6-12%) versus those who did not (6.6%, 31/472, 95% CI 4.6-9.2%; odds ratio 1.38, 95% CI 0.85-2.23), indicating that these criteria would miss 42% of patients (31/74, 95% CI 31-53%) with PGVs. The criteria were less effective at predicting PGVs in patients from under-represented populations. Most PGVs (81%, 60/74) were potentially clinically actionable. Limitations include the inability to stratify analyses based on individual ethnicity due to low numbers of non-White patients with PGVs.

CONCLUSIONS

Our results indicate that almost half of PCa patients with PGVs are missed by current testing guidelines. Comprehensive germline genetic testing should be offered to all patients with PCa.

PATIENT SUMMARY

One in 13 patients with prostate cancer carries an inherited variant that may be actionable for the patient's current care or prevention of future cancer, and could benefit from expanded testing criteria.