Box 2: NCCN Guideline Recommendations for Somatic Testing in Prostate Cancer

Recommend evaluating tumor for alterations in homologous recombination DNA repair genes, such as BRCA1, BRCA2, ATM, PALB2, FANCA, RAD51D, CHEK2, and CDK12, in patients with metastatic prostate cancer. If mutations in BRCA1, BRCA2, ATM, PALB2, and CHEK2 are found and/or there is a strong family history of cancer, refer to genetic counseling for confirmatory germline testing. Patients should be informed that somatic tumor sequencing has the potential to uncover germline findings. However, virtually no somatic NGS test is designed or validated for germline assessment. If a germline mutation is suspected, the patient should be recommended for follow-up with genetic counseling and dedicated germline testing. Tumor testing for microsatellite instability (MSI) or dMMR can be considered in patients with regional or metastatic prostate cancer. Men with lymph node metastases or distant metastases should also undergo tumor somatic testing.