And can you explain what BRCA testing is?
Sure, I mean, genetic testing... BRCA testing is a little subset of genetic testings. There's
a panoply of things that, you know, you go on for days talking about genetic therapy
and genetic diagnosis and whatnot, but BRCA is a gene in our bodies that helps DNA be
properly repaired if there are any mistakes in the replication process. So any time cells
divide they make a whole new set of DNA and it's a complex process and there inevitably
will be mistakes. So, the BRCA gene actually goes through and sorts out those mistakes
and fixes them and that is messed up and broken in, you know, 3-4% of the population and it's
even more common in cancer patients because people that have that gene are more predisposed
to getting advanced cancers, advanced prostate cancer. So, it's relevant to know about it
because those patients that have that particular mutation are more likely to respond to a medicine
that further retards DNA repair. Cancer cells are different than our cells because they
divide and multiply more frequently. They're doing more DNA replication and if a person
has BRCA, those cancer cells aren't repairing the DNA quite as well. So, if you add a medicine
like olaparib (Lynparza) which further retards DNA repair, the number of mutations becomes
so excessive that the cancer cells die. So, identifying the BRCA gene and giving such
individuals Lynparza (or olaparib) and there are other products as well that can be tried.
Those people will high response rates to these medicines and better responses, and so it's
a logical thing to consider in people that have that specific mutation.
So, when it comes to this test, should all prostate cancer patients get it? It's a blood
test, right?
Yeah, you can do genetic testing on the blood or they can do a mouth swab. The men that
have advanced prostate cancer should get genetic testing. Whether all prostate cancer patients
should have it done is debatable. Genetic testing, there's a lot of genetic stuff we
don't know what to do with it yet, and of course, it can be kind of frightening if information
comes in that you've got certain mutations but no one knows what to do with it. So, that's
a downside to genetic testing. The upside is that if you find some sort of a correctable
gene that maybe that will opent he door for a new treatment you wouldn't have otherwise
thought of.
Now, I was reading a couple of articles and they were talking about men who are getting
prostate cancer really early in life, like in their 50s, should get BRCA testing immediately
because of how young they are. Can you speak to that a little bit?
Alright, so prostate cancer is super common as men get older and you don't have to postulate
a family history or a genetic issue for when older men get prostate cancer, but it is less
common in younger men, and so you are thinking that there's a higher chance of some specific
familial mutation that might be detected with testing.
And, when it comes to the test itself. Let's say an advanced prostate cancer patient takes
this test, they find out they have this, do they just talk to their medical oncologist
about the results? Like, what's the next step of action?
Yeah, I mean it's usually ordered by the medical oncologist and so—who's a cancer specialist—and
he'll be probably advising the patient what measures to take. Olaparib, the medicine I
mentioned before, is not free of side effects. It's kind of like a mild chemotherapy. So,
it's not like everybody that has this mutation should immediately go on that type of medicine,
but it's nice to know that you may have one more arrow in the quiver—one more additional
effective therapy to use if the situation looks like it warrants aggressive treatment.
Okay, and is olaparib FDA approved for prostate cancer? Or it's not and it's approved for
another type of cancer?
Right, it's FDA approved for the treatment of ovarian cancer, and there are studies ongoing
to validate its effectiveness in prostate cancer, so it's possible it will be FDA approved.
It can be used on an off-label basis. It can be purchased and in appropriate cases for
prostate cancer.
Okay, and most medical oncologists would be okay with giving something off-label or being
able to purchase that if the person is positive for the BRCA gene?
Yeah, I mean it's always hard to predict what other doctors—when you're talking about
off-label treatments, the—some doctors are very innovative and willing to embark upon
a treatment that isn't FDA approved. Others are concerned that it's outside the box and
maybe not appropriate, so it's hard to say what any specific doctor would do.
So that's really what an important point is with the patient then is making sure that
they know what they have and they know their tests and they have a doctor who is willing
to work with them in these cases and kind of even think outside the box in these serious
cases. Because we see a lot of guys, unfortunately, where the doctor is giving them—I've seen
guys, you know, where they have their oncologist has kept them on Lupron forever and their
PSA is going up to 10, 20, 30, 40, and they're calling us saying, you know, "My doctor should
be telling me to do something different, right? He says to keep looking at it." And I'm sitting
here going, "Why? We know what this is, So I think...
I mean, I would think that might be more common in people that are being managed by urologists,
surgeons. The medical oncologists might want to withhold therapy is someone has a good
quality of life and they don't see an effective, non-toxic treatment that would prolong life,
and if they don't see it, it could be because they're aware or unaware, and that's why it
is good to do your own research and find out what the options are and talk about it with
your doctor.
Alright, well thank you once again Dr. Scholz. These questions, I'm learning every time,
but I'm really excited for the patients to be able to get these answers, and I just really
appreciate it.
Thank you so much for watching this video. We really appreciate it. If you have questions
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