NCCN Updates Prostate Cancer Management Guidelines
The National Comprehensive Cancer Network (NCCN) issued updated guidelines for prostate cancer, including new information about the role of family history, specific mutations, and microsatellite instability testing.
The updated guidelines suggest that men with regional or metastatic prostate cancer should be have their tumors tested for homologous recombination gene mutations and assessed for microsatellite instability or mismatch repair deficiency.
A new footnote was added to the section for risk stratification and staging workup footnotes: “DNA analysis for MSI and IHC for MMR are different assays measuring the same biological effect. If MSI-H or dMMR is found, refer to genetic counseling to assess for the possibility of Lynch syndrome.” The footnote continues with a reference to eligibility for pembrolizumab in later lines of treatment for castration-resistant prostate cancer that is MSI-H or dMMR.
The guideline also recommends testing patients for germline and somatic mutations in DNA repair genes such as BRCA1/2, ATM, PALB2, and FANCA. Patients who test positive for these mutations should be referred for genetic counseling.
The section for risk stratification and staging workup footnotes now includes a recommendation on germline genetic testing and counseling: “The prevalence of inherited homologous recombination gene mutations in men with metastatic or localized high risk was found to be 11.8 percent and 6 percent, respectively.”
The guidelines added the Decipher assay as an option for patients with PSA persistence or recurrence.—Zachary Bessette