Can you really treat prostate cancer effectively without knowing the genetics? In this episode of BackTable Urology, Dr. Evan Yu and Dr. Tanya Dorff join host Dr. Alan Tan to discuss why genetic testing is essential in personalized prostate cancer care. They discuss when and how to perform germline and somatic testing, address common barriers, and share best practices for counseling patients.

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This podcast is supported by an educational grant from Pfizer.

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Timestamps

00:00 - Introduction
02:18 - Who Gets Somatic Testing?
06:43 - Patient Barriers to Testing
09:00 - Genetic Testing Workflow
12:28 - Treating BRCA2 Alterations
24:18 - Monitoring Progression: ctDNA vs. PSA vs. Imaging
29:32 - Treating mCRPC with ATM Mutations
34:39 - CDK12 Classification
37:43 - Closing Takeaways

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More about this episode

The doctors explore how BRCA2 and other DNA repair alterations can directly shape treatment decisions, focusing on the roles of PARP inhibitors and platinum therapy in advanced cases. The discussion highlights why both germline and somatic testing are critical for identifying actionable mutations and discuss the nuances of interpreting test results, including current limitations and emerging biomarkers. They also examine challenges such as insurance coverage, patient misconceptions, and workflow integration, as well as the movement toward truly personalized, biology-driven approaches in prostate cancer care.

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Resources

Niraparib and abiraterone acetate plus prednisone for HRR-deficient metastatic castration-sensitive prostate cancer: a randomized phase 3 trial:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12705445/

Capivasertib plus abiraterone in PTEN-deficient metastatic hormone-sensitive prostate cancer: CAPItello-281 phase III study:
https://www.annalsofoncology.org/article/S0923-7534(25)04936-1/fulltext

Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer:
https://www.nejm.org/doi/full/10.1056/NEJMoa1903307

ARCHES 5-year Survival with Enzalutamide Plus Androgen-deprivation Therapy in Metastatic Hormone-sensitive Prostate Cancer Patients
https://www.sciencedirect.com/science/article/pii/S0302283825048766

First-Line Camizestrant for Emerging ESR1-Mutated Advanced Breast Cancer:
https://www.nejm.org/doi/abs/10.1056/NEJMoa2502929

PROMISE Registry:
https://www.prostatecancerpromise.org/

Talazoparib plus enzalutamide in men with HRR-deficient metastatic castration-resistant prostate cancer: final overall survival results from the randomised, placebo-controlled, phase 3 TALAPRO-2 trial:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00683-X/abstract

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