Patients discuss how genetic and genomic testing, along with participation in research, can provide valuable insights into prostate cancer risk, guide personalized treatment decisions, inform family members, and contribute to advancing future cancer care.
Jeff Pawlak:
I also had genetic testing, and I do have BRCA2. And that really helped me understand what was going on. And I wish I would've had that information prior to being diagnosed with prostate cancer. And the simple reason I say that is, one being married to an oncology nurse, that's a whole different world. You learn so much about all kinds of other medications.
But two, my grandmother and my mom both died of pancreatic cancer. So I know probably more about pancreatic cancer than I do about prostate cancer because I knew it was familial and that I had a really good chance of having it. But I didn't know my medical history from my parents or my grandparents. That was just something that wasn't talked about. So once I had the genetic testing, that just explained a lot of things to me and it helped me understand why, where it came from. And that's where I'm at today.
Mike Hoppel:
So I did join a Vanderbilt cancer research study. So they basically got my body to do whatever they want to with it. They're going to track me for the rest of my life and they're going to do a genealogy on me. And just anything that happens to me, they're going to have a record of this. Because I had a marker that they see in patients. And they had a very good sample of mine available to them. And so they don't understand what that marker means.
And so I have it, and so they were very excited to get me. Because this study had already closed at the time I had my surgery, and while I was in there, they called them and told them that I was available if they needed me. So within 15 minutes they had a team down there with their paperwork and got everything signed because they didn't have enough good samples. And they had the whole sample from me. So that's exciting to be a part of research on this, whatever part of my body they want to do.
Brian McCloskey:
What have I done with my genomic profile information? So it's interesting, I got sequenced fairly quickly right after my first surgery. And it identified three different mutations. Those mutations really weren't clinically actionable. And so that's why I decided that I wanted to go after RNA-Seq. And through the RNA-Seq work that we did, we identified really four different targets to go after that we thought were clinically actionable. And they are.
So for example, I have a very high expression of PSMA, which opens up the door for Pluvicto and hopefully a very positive response. I now have AR copy number gain plus TP53. Those are two distinct cancer identifiers that could play into bipolar androgen therapy. I also have a very high expression of AR in and of itself, so there are AR degraders that I could potentially go after. And as I mentioned, there is another target, which is CD276 or B7H3, which has a clinical trial that it's an antibody drug conjugate that targets that particular gene expression.
So there's four, three or four right there. Again, working with these other providers, we have identified 21 different treatment options. Some of them are combinatorials, where they're looking at certain genes or gene expressions, gene mutations or gene expressions, and then looking at pathways and the drugs that can target each of those different pathways. Those particular treatments are a bit more difficult to implement because of questions around dosing.
But even without those particular treatment options, which I'm still going to hold onto because if we can figure out some of the dosing components, they can be very, very relevant. So 21 was reduced down to about eight, and then from the eight we've solidified around four. And those four will go, they will be systemic treatment options that will follow the surgery that I'm going to have in the next few weeks.
And have you involved your children at all in this genomic profiling?
Brian McCloskey:
Yes. So I don't have... yes. So in terms of involving my children, I don't have any germline mutations, so that's good. I do know other cancer patients who do, and that obviously puts their kids at risk. So for me, my kids are less at risk, but they're also learning through osmosis a new language around genomics. And in my case, it's just all somatic variations. But that's useful for them.
My two boys are sensitized to testing when the time is appropriate. They're fine right now, but as they go through life, they'll have more options for screening. Gallery could be one and there could be others as well. So they don't speak all the language around genomics, but they've learned enough to be dangerous. And they also see the experience that I've had, and I think that they're just sensitized to how to detect and how to manage things.
Roland Bessette:
The first week we had a couple of extra meetings. One was with genetics, asking if it would be possible if they could have some vials of blood done so that they could help. Well, my reaction there was, I said, "Of course." I says, "You mean people don't say yes?" She says, "That's right." And I says, "What's wrong with them?" Then the following week we had somebody that came in and said, "Listen, we're a student of the studies.
If you have any biopsies, can we have what's left over?" And I'm like, "Yeah." And I says, "I assume that people don't do that." She goes, "You're right." I says, "Well, no, do it." And if you're going to go there and you're going to be treated, you need to share. And so after that, then it was every third week we'd go, and I had a bunch of friends of mine, some regular friends and other work friends that I used to work with, and they wanted me to send a note out with them letting them know after every treatment I had. And so I did that as well.