Germline Predisposition to Prostate Cancer in Diverse Populations
There remains a paucity of data related to germline genetic alterations predisposing patients to prostate cancer. Recent data suggest that African American, Hispanic, and Asian and Pacific Islander men exhibit genetic alterations in both highly penetrant germline genes, including BRCA1/2, ATM, and CHEK2, and the mismatch repair genes associated with Lynch syndrome, as well as low-penetrant single-nucleotide polymorphisms. However, cohort sizes remain small in many studies limiting the ability to determine clinical significance, appropriate risk stratification, and treatment implications in these diverse populations. (Sourc...
Source: Urologic Clinics of North America - June 11, 2021 Category: Urology & Nephrology Authors: Kelly K. Bree, Patrick J. Henley, Curtis A. Pettaway Source Type: research
Genetic Contribution to Metastatic Prostate Cancer
This article reviews key literature on individual genes, recognizing BRCA2 as the gene most commonly altered in the metastatic setting. This article discusses the importance of representative and diverse inclusion, and efforts to advance management for at-risk carrier populations to maximize clinical benefit. (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - June 10, 2021 Category: Urology & Nephrology Authors: Alexandra O. Sokolova, Elias I. Obeid, Heather H. Cheng Source Type: research
Genetically Informed Prostate Cancer Treatment for Metastatic Disease
Germline testing should be performed to support treatment selection for patients with metastatic prostate cancer, and should be identified in patients with high-risk localized disease. Patients with germline BRCA1/2 mutations should be educated regarding additional personal cancer risk, and risk for family members. Guidelines recommend that all men with metastatic prostate cancer should also undergo somatic tissue and germline testing for priority genes BRCA1/2, PALB2, ATM, and MSH2/6. The advent of high throughput sequencing enables patients to be tested for a more comprehensive panel of germline and somatic mutations. (S...
Source: Urologic Clinics of North America - June 10, 2021 Category: Urology & Nephrology Authors: Aisha L. Siebert, Brittany M. Szymaniak, Yazan Numan, Alicia K. Morgans Source Type: research
Polygenic Risk Scores in Prostate Cancer Risk Assessment and Screening
More than 40% of the risk of developing prostate cancer (PCa) is from genetic factors. Genome-wide association studies have led to the discovery of more than 140 variants associated with PCa risk. Polygenic risk scores (PRS) generated using these variants show promise in identifying individuals at much higher (and lower) lifetime risk than the average man. PCa PRS also improve the predictive value of prostate-specific antigen screening, may inform the age for starting PCa screening, and are informative for development of more aggressive tumors. Despite the promise, few clinical trials have evaluated the benefit of PCa PRS ...
Source: Urologic Clinics of North America - June 10, 2021 Category: Urology & Nephrology Authors: Lindsey Byrne, Amanda Ewart Toland Source Type: research
Genetically Informed Prostate Cancer Screening
Prostate cancer represents a significant health care burden in the United States due to its incidence, treatment-related morbidity, and cancer-specific mortality. The burden begins with prostate-specific antigen screening, which has been subject to controversy due to concerns of overdiagnosis and overtreatment. Advancements in molecular oncology have provided evidence for the inherited predisposition to prostate cancer, which could improve individualized, risk-adapted approaches to screening and mitigate the harms of routine screening. This review presents the current evidence for the genetic basis of prostate cancer and n...
Source: Urologic Clinics of North America - June 10, 2021 Category: Urology & Nephrology Authors: Rohith Arcot, Todd M. Morgan, Thomas J. Polascik Source Type: research
Overview of Prostate Cancer Genetic Testing
Prostate cancer (PCa) remains the most common solid malignancy in men in the United States. Contributing to 33,330 deaths in 2020 in the United States, it is second to only lung cancer as a cause of cancer death in men in 2020.1,2 (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - June 10, 2021 Category: Urology & Nephrology Authors: Thenappan Chandrasekar, William K. Kelly, Leonard G. Gomella Source Type: research
Germline Testing for Prostate Cancer Prognosis
Available evidence supports routine implementation of germline genetic testing for many aspects of prostate cancer (PCa) decision making. The purpose of obtaining genetic testing for newly diagnosed men would be focused on identifying mutations that predispose to aggressive PCa. Based on an evidence-based review, the authors review germline rare pathogenic mutations in several genes that are significantly associated with aggressiveness, metastases, and mortality. Then recent studies of these germline mutations in predicting tumor grade reclassification among patients undergoing active surveillance are discussed. Single nuc...
Source: Urologic Clinics of North America - June 10, 2021 Category: Urology & Nephrology Authors: Brian T. Helfand, Jianfeng Xu Source Type: research
An Updated Review on Physician Burnout in Urology
Physician burnout is an issue having an impact on all of medicine but having a significant impact on the field of urology. Burnout begins in medical school and worsens in residency. Increased workload leads to increased burnout both in residency and in practice. Issues with work-life balance, electronic medical record usage, decreasing reimbursements, and increased Centers for Medicare& Medicaid Services burden all have an impact on physician satisfaction with their practices. Burnout should be acknowledged, and measures for prevention should be taken by hospitals and residency programs to decrease and prevent physician bu...
Source: Urologic Clinics of North America - March 30, 2021 Category: Urology & Nephrology Authors: Jennifer Nauheim, Amanda C. North Source Type: research
Embracing Change in Urologic Practice: Both Without and Within
This is the only the second time that this prestigious publication has devoted an entire issue to the socioeconomics of health care. Given the upheaval associated with the global Public Health Emergency and the current political uncertainty in the country, the timing of the Urologic Clinics for such a review couldn ’t be more appropriate. The protective bubble that has sheltered physicians from the harsh economic realities other professions face has burst—not only have we seen our livelihoods threatened but also our very lives as front-line workers are at risk as we minister to our patients. (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - March 30, 2021 Category: Urology & Nephrology Authors: Deepak A. Kapoor Tags: Preface Source Type: research
Between the Forty-Yard Lines: Health Care Reform and its Impact on the Changing Landscape of Urologic Practice
Late last year, I had the opportunity to attend a Zoom interview of David Gergen. He has served in the administrations of both political parties and has been a keen observer of how things get done within the Beltway throughout his distinguished career. He is, in my opinion, a man of uncommon wisdom. During the interview, he shared that he thought that in Washington, DC most things get accomplished “between the forty-yard lines.” I think it is an apt metaphor for the current political environment regarding health care reform, which is the underpinning for the changing landscape of urologic practice. (Source: Urologic Cl...
Source: Urologic Clinics of North America - March 30, 2021 Category: Urology & Nephrology Authors: Kevin R. Loughlin Tags: Foreword Source Type: research
The Changing Landscape of Urologic Practice
UROLOGIC CLINICS OF NORTH AMERICA (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - March 30, 2021 Category: Urology & Nephrology Authors: Deepak A. Kapoor Source Type: research
Copyright
ELSEVIER (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - March 30, 2021 Category: Urology & Nephrology Source Type: research
Contributors
KEVIN R. LOUGHLIN, MD, MBA (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - March 30, 2021 Category: Urology & Nephrology Source Type: research
Contents
Kevin R. Loughlin (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - March 30, 2021 Category: Urology & Nephrology Source Type: research
Forthcoming Issues
Prostate Cancer Genetics: Changing the Paradigm of Care (Source: Urologic Clinics of North America)
Source: Urologic Clinics of North America - March 30, 2021 Category: Urology & Nephrology Source Type: research
