Dr. Scholz, one of the commenters would like to know if there's any treatments related to
genetic testing besides PARP inhibitors for BRCA mutations or Keytruda for MSI?
So, the whole genetic world is just starting to open up. We're right at the beginning, and the two
very useful things that can be detected on genetic testing that could really help people, you just
mentioned them, and sometimes it's easier to work backwards from what's available rather
than work forwards from all the many many different opportunities and possibilities.
We've already done a video from Joanne Weidhaas at UCLA who's
investigating genetic testing of micro-RNAs, and these microRNAs are regulatory and they're
very powerful, and with the genetic testing that they're doing they can
sense or detect who is going who is more likely to have side effects from radiation therapy
and the different types of radiation therapy. They can also detect who's likely to have more
side effects with some of the immune therapies like Keytruda, and so this is very useful,
these medicines and radiation of course are very useful for people, but if they cause
toxicity it can be quite a problem. So, to be able to detect in advance who's likely to have problems
is is a wonderful advantage of genetic testing. The initial hope of genetic testing was that we'd
be able to do a broad spectrum of genetic tests to look for specific abnormalities that would lead to
effective therapies and occasionally that pans out. You mentioned the two most common ones
already BRCA and MSI for which we know we have a useful treatment. The other less common mutations,
we usually try and get a read through other cancers, for instance, lung cancers may have a
specific mutation for which a therapy is available and sometimes those lung cancer mutations show up
in prostate cancer. So, that's the hope when we do genetic testing, and of course,
it's easy to do genetic testing. We can now do it onon a blood test a Guardant360 or foundationOne,
and they'll run a whole panel of genetic tests. Practically speaking, how often do those
other genetic abnormalities show up and provide a really wonderful insight into a brand new therapy,
and the answer is unfortunately not that often. So, the BRCA and MSI
is certainly useful and everyone should have genetic testing that has advanced prostate cancer
to see if that mutation is present. Occasionally one of these other mutations will come through
and show another opportunity for a medicine that might be useful. I wish it was more common and
it's not often proving to be useful and we're not finding mutations frequently enough to
really get excited about broad-spectrum genetic testing, but occasionally we do get lucky.
So, what percentage of patients would be testing positive for BRCA?
Yeah, so BRCA mutations occur in about 10% of men with advanced
prostate cancer and about 5% of men with early-stage prostate cancer so it's not
overwhelmingly common but it's common enough that you certainly want to test everybody for it.
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