The new guidelines recommend consideration of germline genetic testing in the following patients:

• All men with high-risk, very high-risk, regional, or metastatic prostate cancer
• All men with any stage prostate cancer and a family history consisting of one (or more) of the following:
  • Brother, father, or multiple family members diagnosed with prostate cancer at <60 years of age; or
  • Family member with a known mutation; or
  • More than one relative with breast, ovarian, or pancreatic cancer (suggests possibility of BRCA2 mutation) or colorectal, endometrial, gastric, ovarian, pancreatic, small bowel, urothelial, kidney, or bile duct cancer (suggests possibility of Lynch syndrome)

Germline genetic testing in castrate-resistant prostate cancer may help guide medical management such as:

• Genetic counseling
• Early use of platinum chemotherapy
• Eligibility for clinical trials with PARP inhibitors
• Eligibility for pembrolizumab (Keytruda^®) in later lines of treatment (following tumor testing for microsatellite instability or mismatch repair deficiency)

¹Referenced with permission from the NCCN: Prostate Cancer. Version 1.2018. © National Comprehensive Cancer Network, Inc. 2018. All rights reserved. Accessed February 26, 2018. To view the most recent and complete version of the guideline, go online to NCCN.org.
The NCCN Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines^® are a statement of consensus of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines^® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.