How Genomic Testing Can Help Guide Advanced Prostate Cancer Treatment

If you’ve been diagnosed with advanced prostate cancer, you may hear your healthcare provider talk about genomic testing. But what exactly does that mean? And why does it matter?

Urologic oncologist Zeyad Schwen, MD, explains what genomic testing is and how it can provide your care team with valuable information to help guide your treatment.

Understanding genomic testing for prostate cancer

The goal of genomic testing is to understand the unique biology of the specific tumor that you’re living with. Those results can help your care team better understand how to treat it.

Genomic testing analyzes genes and genetic changes in cancer cells. These changes can offer clues about which treatments may be most effective. It’s done using tissue collected during a prostate biopsy or surgery (or in some cases, through liquid biopsy).

“Genomics looks at the tissue from a tumor where there’s been a mutation,” Dr. Schwen explains. “It looks at specific things that went wrong that may predict the biology of the cancer and how this type of tumor behaves or what treatments they will respond to.”

Genomic testing is different from germline genetic testing, which looks for inherited DNA changes that can run in families. Instead of examining the DNA you were born with, genomic testing analyzes the tumor itself to look for changes that may help guide treatment.

How genomic testing helps guide treatment decisions

Early on in a cancer diagnosis, genomic testing may help determine how aggressive a cancer is and whether it’s likely to spread. But if you’re already living with advanced prostate cancer, genomic testing is looking for RNA changes that could tell your care team which treatment is most likely to work or whether less aggressive management is possible.

“At the beginning, after a prostate biopsy, genomic testing can help us determine the initial treatment plan,” Dr. Schwen explains. “But if you’ve developed metastatic disease, it can help determine whether you’re a candidate for certain therapies and direct what comes next.”

The results of genomic testing for advanced prostate cancer might lead your doctors to consider treatment options or opportunities like:

• PARP inhibitors
• Immunotherapy
• Clinical trials

“We want to figure out if we can personalize your therapy to fit the cancer’s biology,” he adds.

If your healthcare provider has recommended genomic testing, they can tell you more about what the tests are trying to find and how the results may affect your treatment.

What else informs your treatment plan

Genomic testing results aren’t the only thing that guides your providers in their treatment decisions. There are also other factors to take into account, including:

• PSA (prostate-specific antigen) levels
• Imaging results
• Biopsy findings
• Tumor grade

“Genomic testing gives us a better picture that we can use, in combination with other tools, to find the best treatment strategy for you,” Dr. Schwen notes. “But we never rely on just one test.”

Final thoughts

As researchers continue learning more about the biology of prostate cancer, genomic testing is starting to play a bigger role in personalized cancer care.

No single test can tell the whole story about the cancer you’re living with. But Dr. Schwen reiterates that genomic testing can provide important information to help your care team tailor treatment to your specific situation.

“Genomic testing helps us understand the biology of the cancer, which adds another piece to the overall picture,” he states. “And that can help us create a more personalized treatment plan.”