b'uFromPage 57time we will see a difference in survival but it mayreaching 33% in 2020 and 40% in 2021. 2take longer follow up and more patients. Ofthosetested,15%werepositiveforapatho-genicHRRmutation,suchasBRCA2,forwhich Molecular Testingpoly(adenosinediphosphate-ribose)polymerase Treatment intensification can slow or prevent met- (PARP) inhibitors olaparib and rucaparib are approved astatic prostate cancer from becoming castrationtreatments.Othertherapiesforcommonmutations resistant or failing to respond to ADT, but still,include pembrolizumab for prostate cancer patients many patients will develop this more challengingwith microsatellite instability-high (MSI-H) or mis-form of the disease. In recent years, treatment op- match repair-deficient (dMMR) cancer.tions for mCRPC have multiplied, offering hopeAs metastatic prostate cancer is a highly heteroge-for longer survival. neous disease, increased testing to identify new thera-Many of the new treatments for mCRPC, how- peutic targets and better match treatments is needed. ever,aretargetedtherapiesthatrequiretumorArecentstudyfoundtwonewclustersofmuta-testingforappropriateselection.Consequently,tionalsignaturesthatbearfurtheranalysis.These NationalComprehensiveCancerNetworkguide- includedknownclinicallyactionablemutations linesrecommendgenetictestingforallpatientsinSMO,ABL1,MET,ALK,FGFR2,andJAK3. with metastatic prostate cancer, which can identifyAdditionally,weidentifiedmutationsinSMAD4/thosewithactionablehomologousrecombinationTGF(NCT02452008),ROS1,PTEN,EGFR,and repair (HRR) pathway mutations and other variantsBRAF, where therapies are currently being explored with therapeutic targets. in the MATCH Trial (NCT02465060). We also identi-In partnership with the Prostate Cancer Foundationfied mutations in GNAS that warrant further clinical since 2016, the VA has striven to improve access toexploration if confirmed in another larger cohort, the and use of both tumor testing for somatic mutationsresearchers noted. 3and germline testing for hereditary mutations that1George DJ, Agarwal N, Ramaswamy K, Klaassen Z, et. Al. Emerg-couldaffectresponsetotargetedmedications. Aing racial disparities among Medicare beneficiaries and Veterans partnership with Foundation Medicine Inc. estab- with metastatic castration-sensitive prostate cancer. Prostate Cancer lished in 2019 dramatically increased comprehen- Prostatic Dis. 2024 Apr 2. doi: 10.1038/s41391-024-00815-1.sive genomic profiling. 2Hung A, Candelieri D, Li Y, Alba P, et. Al. Tumor testing and treat-Of 9,852 veterans with mCRPC diagnosed betweenment patterns in veterans with metastatic castration-resistant prostate 2016and2021,20%receivedtumortesting,withcancer. Semin Oncol. 2023 Feb-Apr;50(1-2):11-24.nearly three-quarters of that testing occurring in 20203Hernandez KM, Venkat A, Elbers DC, Bihn JR, et. Al. Prostate cancer patient stratification by molecular signatures in the Veterans Precision and 2021. In 2016-2017, less than 2% of veteransOncology Data Commons. Cold Spring Harb Mol Case Stud. 2024 received testing. Testing rates rose rapidly after 2019,Jan 10;9(4):a006298.PHOTO WITH CUTLINE TK3-D rendered medically accurate illustration of an inflamed prostateSource:Sebastian Kaulitzki/Shutterstock58'