August 8, 2023

Genetic testing and customized cancer care

Harold Newman had advanced prostate cancer. Genetic testing helped expand his future treatment options and safeguard the health of his family members.

Newman’s successful treatment allowed him to continue pursuing his passions: hiking, birding, succulent gardening, and spending time with his family.

As a retired doctor, Harold Newman knew he needed to see a doctor when he noticed that he was urinating more often than usual.

He assumed the cause was an enlarged prostate gland. As men age, the prostate often gets bigger. This can cause a frequent or urgent need to urinate.

“Even though I didn’t have any other symptoms, my doctor ordered a PSA test to rule out prostate cancer,” said Newman, a Kaiser Permanente member who was 70 years old at the time. “This turned out to be a critical step, because my PSA levels were really high.”

Further testing revealed Newman had prostate cancer. And it had spread to the lymph nodes in his pelvis.

The most common symptom of prostate cancer is difficult or painful urination. When prostate cancer spreads, patients may experience bone pain, weight loss, or swelling in their legs and feet.

But it isn’t uncommon to have very mild symptoms, as in Newman’s case — or even to have no symptoms at all.

Prostate cancer can be difficult to detect and diagnose. Newman felt extremely lucky that his care team discovered the cancer when they did.

Consulting with a team of specialists

Because the cancer had spread beyond his prostate, Newman’s doctors didn’t recommend surgery.

Instead, he first received a hormone-blocking drug to stop his body from producing testosterone. Most prostate cancer cells feed on testosterone. Reducing testosterone levels can cause cancer cells to die or grow more slowly.

Nearly 10%

Of prostate cancers
are related to
inherited gene mutations

Andrea Harzstark, MD, a genitourinary medical oncologist at the Kaiser Permanente San Francisco Medical Center, also recommended targeted radiation therapy to destroy cancer cells.

This combination of treatments was successful. Newman’s cancer was no longer detectable, and his PSA levels returned to normal.

Genetic testing can help identify targeted treatment options

Newman’s care team also recommended genetic testing shortly after his diagnosis. About 10% of prostate cancers are related to inherited gene changes called mutations.

After a simple blood draw, his sample was sent to the lab for genetic testing. He learned he has a BRCA2 mutation. (BRCA, pronounced "BRAH-kuh," is short for BReast CAncer.) BRCA mutations can be passed down through families.

“Mutations in the BRCA1 and BRCA2 genes are much more well-known for increasing the risk of breast and ovarian cancer,” Dr. Harzstark explained. “But in the past few years, we’ve learned that they play an important role in prostate cancer, as well.”

Genetic testing can help identify targeted treatments for people with cancer. Sometimes it helps right away, and sometimes patients benefit years after their original diagnosis and treatment.

“If a genetic test shows that a patient has a certain mutation,” Dr. Harzstark said, “and we only learn years later that it’s significant, our genetics team has a mechanism where they can go back through patient records and help identify everyone who could benefit from this new knowledge.”

For example, in 2020, 4 years after Newman’s diagnosis, a category of drugs called PARP inhibitors was approved by the FDA as an effective medicine for patients with a BRCA mutation and advanced prostate cancer.

Even though his initial treatment was successful, Newman feels even better now that there’s a specific and effective option ready to go if his prostate cancer comes back.

Genetic testing can help protect your family’s health

Genetic testing can help inform decisions about whether a patients’ family members should be screened to see if they have genetic mutations, as well.

Kaiser Permanente’s genetics department is unique because it’s part of our connected care model. When several members of the same family are Kaiser Permanente members, the results of genetic tests become a part of their electronic health record. This can help guide personalized screening recommendations and other customized care across generations.

For example, Newman has 2 children who are both in their mid-40s. Testing revealed that his son also has the BRCA2 mutation. His daughter doesn’t have it.

As a result, Newman’s son is taking specific steps to safeguard his health. He’ll get screened for the types of cancer related to BRCA2 more regularly because of his increased risk. The aim is to detect cancer early, when it’s far easier to treat.

“This is why genetic testing is so important,” Newman said. “It expanded my treatment options, and it’s protecting my family’s health, too.”

If you have a family history of prostate cancer, ask your doctor whether genetic testing or earlier screening might be right for you.