When and how are you incorporating tumor sequencing to plan treatment of metastatic prostate cancer?  

Presently, the main categories of actionable DNA based alterations in advanced prostate cancer are 1) alterations in homologous repair enzymes like BRCA2, and 2) microsatellite instability (MSI high status, mismatch repair gene deficiency). These are actionable as they can lead to the use of a thera...

I believe the key to NGS is to perform it early, and I strongly favor separate germline and somatic sequencing, given the implications of germline testing for family members. I offer germline NGS to all patients with metastatic prostate cancer and those with high risk localized prostate cancer and s...

It is unclear at this time where in the patient's treatment that timeline PARP inhibitor therapy will be appropriate. Clinical trials are being done at the mCRPC pre and post chemotherapy, mostly for regulatory reasons for drug approval. Given this level of uncertainty, I would recommend genomic te...

I obtain NGS with ctDNA when a biopsy is inaccessible or unsafe, or when there’s likely not enough tumor tissue (such as on a bone biopsy). I will often obtain ctDNA testing when patients have disease progression on their AR-targeted treatment, or either during or after chemotherapy. With PARP...

I obtain both germline and somatic testing for all advanced prostate cancer patients, including all hormone sensitive and resistant patients. I obtain germline testing in all high risk localized and low risk patients who have concerning family history of cancer. Other researchers and I and educato...