Mayo Clinic Archives

Universal Germline Screening in Prostate Cancer: The Argument Against

Posted by Alan H. Bryce, MD | Jan 2021

Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic in Scottsdale, Arizona, argues against universal germline screening in prostate cancer in a point-counterpoint debate. While he agrees that identifying germline mutations is important and can have important implications for therapy and for patients’ families, Dr. Bryce observes that very few carriers are identified through germline testing. Approximately ⅔ of carriers are identified through family history-based screening, and while germline mutations are more common in men with metastatic cancer, they are uncommon in the total prostate cancer population. This means that among low- and intermediate-risk patients, 200-300 people must be screened to find one additional carrier, and among high-risk patients, approximately 50 people must be screened to find an additional carrier. Genetic testing costs money and takes up valuable counseling time, so Dr. Bryce argues that testing all patients is not a sensible allocation of resources.

COVID-19 Vaccine Roundtable Discussion

Posted by E. David Crawford, MD | Jan 2021

E. David Crawford, MD, Professor of Urology at UC San Diego and Editor-in-Chief of Grand Rounds in Urology, interviews Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, and Neil H. Baum, MD, Professor of Urology at Tulane Medical School, about the COVID-19 vaccine—how it works, its safety, and possible side effects. Currently, Pfizer and Moderna have each created a vaccine for the novel coronavirus, both of which are mRNA vaccines containing code for the protein found within the virus. Dr. Bryce describes how this portion of RNA causes cells to synthesize what is known as a “spike protein,” which then stimulates an immune response. He observes that side effects are typically mild and similar to what one could expect with a standard flu vaccine, notwithstanding rare, severe reactions. Dr. Baum then addresses the psychological manifestations associated with COVID-19, such as anxiety, fear of contracting or spreading the disease, PTSD, depression, and even suicide. It is important to note that these symptoms are also associated with burnout which, within the medical community, impacts urologists to a greater degree. Dr. Baum warns that the stress of being a frontline worker, decreases in income, and the shift from in-person to telehealth appointments and related “Zoom fatigue” may further increase burnout among urologists.

Metastasis-Directed Therapy: Radiation Oncology Updates and Perspective

Posted by Steven E. Finkelstein, MD, FACRO | Oct 2020

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses metastasis-directed therapy (MDT) as a potential treatment option for oligometastatic prostate cancer. He reviews typical management of metastatic cancer and describes how MDT can minimize the toxicity of systemic therapy, then addresses future treatment options with stereotactic ablative radiotherapy (SABR). Radiation and other local therapies are used for palliation of metastases but can also alter the course of tumor development. Dr. Finkelstein explains that MDT can be particularly beneficial in oligometastatic prostate cancer if the metastases are at a point where both the primary tumor and metastases can be treated together and likely cured. Lastly, he concludes that MDT via SABR could be employed concurrently with other treatments such as androgen deprivation therapy (ADT), chemotherapies, and radiopharmaceuticals, and that further research is necessary.

Updates in PARP Inhibition and Germline Testing in Prostate Cancer

Posted by Alan H. Bryce, MD | Oct 2020

Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, outlines recent treatment updates for prostate cancer patients, beginning with a brief review of germline testing recommendations. Following this, Dr. Bryce discusses two newly-approved PARP inhibitors that target mutations: rucaparib and olaparib. Dr. Bryce then poses a series of questions and challenges that physicians should consider as ongoing trials for various disease states and combinations (neoadjuvant, metastatic castrate sensitive prostate cancer, firstline metastatic castrate resistance prostate cancner, PARP inhibition + immunotherapy, etc.) continue.

Genetics and Biomarkers for Prostate Cancer and Bladder Cancer

Posted by Alan H. Bryce, MD | Oct 2020

Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, discusses genetics and biomarkers for prostate cancer and bladder cancer. Genetic testing is now considered part of best practice for the treatment of cancer, but even still the topic can be confusing due to the number of different test types and scenarios. In order to combat this confusion, it is important that urologists continue to educate themselves on the matter. Dr. Bryce discusses the purpose of using either germline or somatic tests and the different information they can tell us. He goes into particular detail about the somatic test and how useful it can be in determining which targeted therapies to use for both prostate and bladder cancer. Finally, he also offers some advice on best practices for utilizing the somatic test including: testing every patient, always using a fresh biopsy, and retesting before each line of systemic therapy.