GENETIC AND GENOMIC TESTING

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Genetic testing (hereditary testing) examines the blood for mutations in genes (e.g. DNA repair genes) that are associated with a predisposition to developing prostate cancer such as BRCA 1/2, MSH2, and CHEK 2.  This is a simple blood test. Some may also result in other cancers (MSH2 Lynch Sydrome - colon, urothelial of the kidney, prostate). This is a blood test which may pick up a known mutation associated with cancer development or a variant of uncertain significance (i.e. it is in the same gene but the specific amino acid change does not result in definite development of cancer). If an individual carries a mutation they may want to have their kids tested to see if this genetic material was passed on (cascade testing). If a high risk mutation is inherited then screening should occur much earlier.  

 
Genomic testing (e.g. Decipher, Oncotype DX, Prolaris) examines the biopsy cores to see what genes are turned on or off that may make the cancer more aggressive. The analogy I like to use is imagine two identical looking 1966 Camaros. From the outside they look the same. Under the hood, however, one has a 200hp 6 cylinder while the other has a 383 stroker with a supercharger on it. Genomic testing can help individualize prognostic information and help you choose between a more conservative option like surveilance and more proactive option like focal therapy. I recommend genomic testing for low and intermediate risk disease. High risk disease usually doesn't need this information since we already know it is aggressive by its morphology.