So what's getting a lot of attention lately are PARP inhibitors.
So, long story short, these oral drugs — there's a couple now approved in castrate-resistant prostate
cancer that go after genetic mutations. Do you want to just talk a little bit about them in
any direction you want to go in? Because it's now a new option out there for some patients,
these pills that exploit the fact that either your tumor has some genetic mutation or
even when you do a test maybe you were born with one of these things,
so I thought you could give your little take on it because it's a hot topic.
Yeah and it should be a hot topic. The only thing is, it's not a topic that necessarily will impact
most patients with prostate cancer because the kind of genetic findings that are usually required
for successful treatment with these PARP inhibitors are few and far between, meaning that
maybe in between 10% and 25% of men may have these at any point in the course of their disease. So,
the parp inhibitors, at least right now, not going to be for 100 percent of patients,
but I think the important thing to know is, how are you going to know unless you test?
Yes.
If you find this, you know, any of the genetic abnormalities, and really the
ones that we're finding where PARP inhibitors are most effective is in the BRCA-1 BRCA-2 mutations.
Whether those happen in the tumor and or, you know, in the body that you inherited.
So, you know, it's really important for anybody with metastatic disease
to have some testing done on that, and we're even in the NCCN suggesting patients who had
high-risk localized disease, and I advocated for men with biochemical relapse because frankly
if you have a biochemical relapse, you are already high-risk, right?
You've already relapsed. I don't think the NCCN put that in there, but I mean I do it in...
No, I think that's awesome.
bio-chemical relapse. But I mean the testing that can be done
very easily is germline testing, so either they can take blood, they they oftentimes use saliva;
it's not all that costly, and, you know, you can get that anytime and it's no big deal.
Yes.
It is a big deal, however, if you are found to have one of those mutations that's related to
familial cancers that you be seen by a genetic counselor and advised about how your family
members should be tested or not and so forth and what implications it might have for them,
but you know, the other kind of testing we do that's a little more challenging is tumor testing.
You know, so we we take a piece of the tumor from wherever, oftentimes, it's, you know, from
somewhere, you know, a lymph node, for example. I mean, bone we can do,
but it's harder to get a good quality sample, but we can also look in some circulating
DNA that's from the tumor in the bloodstream. So, there's these different ways of testing
again for some of these mutations. Now, when we look at the tumor, we're not only looking at these
you know BRCA-1 BRCA-2 type mutations where PARP inhibitors are useful,
but also some other mutations where other drugs may actually target that in the tumor tissue. So,
there's you know two types of therapy options that you might have by doing that testing. So,
the bottom line is, you know, this genetic testing is here to stay, and there's a lot more we need to
learn about it, but it's here to stay, and it's an important thing that I think patients should
definitely take some time to learn about that.
Yeah, because you're calling for it potentially
to be utilized earlier when someone fails therapy early on.
Well, yeah, because, you know, the thing is if we know — So first of all,
if a guy has high-risk disease, I mean it may signal that there's something in the family and
it's really important for us to address that with family members. It also tells us well,
down the line we, you know, we might need to use a PARP inhibitor on this person.
Yes.
but we already know that, you know,
even before he gets metastatic because we already have that piece of data.
So anyway, I just, I like to do it that way and I try to do it that way in all my patients.
I mean that makes a lot of sense in my mind because I remember just a couple years ago, "let's
test everybody that has advanced disease," oh that might be aggressive, and now you're supposed to do
that, and now if someone fails curative therapy, you know, there's a reason, and so it'd be nice to
know for the patient as well as the family — maybe there's something running through your family? So,
I bet you if we do this interview in a year or two they're going to be calling for that universally;
it's just going to take a year or two to get there.
Yep, I agree with you. I think so.