How to cite: Bratslavsky G. “Germline and Somatic Testing in Prostate Cancer.” Grand Rounds in Urology. August 2026. Accessed Oct 2026. https://grandroundsinurology.com/germline-and-somatic-testing-in-prostate-cancer/
Summary
In this presentation from the UroCancer Interdisciplinary Forum 2026, Gennady Bratslavsky, MD, Professor and Chair of the Department of Urology, SUNY Upstate Medical University, Syracuse, New York, discusses the growing role of germline and somatic genomic testing in prostate cancer, focusing on the practical barriers to widespread implementation. He centers on three persistent challenges: identifying which patients should be tested and when, addressing limitations in genetic counseling capacity, and determining how genomic findings translate into meaningful clinical action.
Dr. Bratslavsky explains the important differences between germline and somatic testing and discusses when each should be considered during the course of prostate cancer care. He reviews current recommendations for patients with metastatic, node-positive, and high-risk localized disease, as well as those with significant family histories or inherited cancer risk factors. He also examines the growing role of somatic tumor profiling, including evaluation of homologous recombination repair genes, microsatellite instability, and tumor mutational burden.
The persistent gap between guideline recommendations and real-world testing rates is addressed. Dr. Bratslavsky discusses barriers, including limited access to genetic counselors, workflow constraints, insurance considerations, and clinician uncertainty in interpreting genomic results. He reviews several practical solutions, including clinician-led counseling, point-of-care testing models, educational resources, and artificial intelligence-assisted patient identification.
Dr. Bratslavsky reviews how genomic testing influences treatment selection, emphasizing that its benefits extend beyond drug selection. Germline testing also supports cascade testing of family members, informs cancer screening strategies, and improves identification of patients who may benefit from precision oncology approaches and future clinical trials.
ABOUT THE AUTHOR
Gennady Bratslavsky, MD, is Professor and Chair of the Department of Urology at SUNY Upstate Medical University in Syracuse, New York, where he also serves as the Phillip Capozzi, MD Endowed Professor of Urology, Professor of Biochemistry and Molecular Biology, and Director of the Prostate Cancer Program. He is a fellowship-trained urologic oncologist specializing in the surgical and multidisciplinary management of kidney, bladder, prostate, testicular, and penile cancers, with particular expertise in robotic and minimally invasive urologic surgery.
