NEW YORK – The National Comprehensive Cancer Network (NCCN) on Thursday updated one of its familial genetic risk guidelines to include prostate cancer recommendations alongside breast, ovarian, and pancreatic cancer.
The guidelines previously included clinical and family history criteria to guide which patients needed testing for cancer susceptibility genes for breast, ovarian, and pancreatic cancers. The update adds a section dedicated to prostate cancer that details which patients should receive genetic testing for hereditary cancer risk.
Patients with a personal history of prostate cancer at any age who have metastatic or node-positive disease, or very high-risk or high-risk disease should be tested for cancer susceptibility genes. Patients should also receive genetic testing if they are of Ashkenazi Jewish ancestry; have one or more close relatives who had young-onset breast cancer, male breast cancer, ovarian cancer, pancreatic cancer, or prostate cancer; or three or more relatives on the same side with prostate or breast cancer.
For patients who do not have cancer, testing is indicated if they have a first-degree blood relative meeting any of the family history criteria.
Testing may be considered for patients who are younger than 55 years of age and have a personal history of prostate cancer or for patients who have a personal history of prostate cancer who have clinical features associated with intermediate-risk cancer, such as intraductal or cribriform histology, according to the guidelines.
Relevant genes to test for hereditary prostate cancer include ATM, BRCA1, BRCA2, CHEK2, HOXB13, and TP53, according to the guidelines. For all four cancer types included in these guidelines, NCCN also recommends genetic counseling before and after germline testing.
Previously, the hereditary cancer risk guidelines for prostate cancer recommended oncologists gather information at the time of diagnosis about a patient's family and personal history of cancer and known germline cancer variants. If a prostate cancer patient met the family or personal history criteria outlined in the general testing criteria for hereditary cancer, NCCN recommended germline testing along with pre- and post-test genetic counseling.
Last month, the NCCN also updated its familial genetic risk guidelines for colorectal and gastric cancer to also include testing recommendations for Lynch syndrome in endometrial cancer, added new recommendations for managing CDH1-associated and APC-associated gastric cancer risk, and removed the recommendation for enhanced colorectal cancer screening for patients with CHEK2 mutations.
"These expanded guidelines reflect the recommendations from leading experts on genetic testing based on the latest scientific research across the cancer spectrum, consolidated into two convenient resources," NCCN CEO Crystal Denlinger said in a statement. "This information is critical for guiding shared decision-making between healthcare providers and their patients, enhancing screening practices as appropriate, and potentially choosing options for prevention and targeted treatment choices."