Somatic Testing

The genetic (germline) test shows you which prostate cancer related genes you may have inherited from your parents (BRCA1/2, ATM,
CHEK2, HOXB13, MSH2, etc.).

The genetic (somatic) test shows you which genes you have acquired (mutated variants) caused by cell mutations or environmental factors (but not inherited). Results from these tests may impact treatment decisions.

Thanks Brian! That’s my understanding as well but I’m concerned that when the results come back, MO will say “Welp, there is nothing we can do for you”

I know many people that have had somatic testing. In some cases, they have found BRCA2 And been able to give that person a PARP Inhibitor when it wasn’t in their hereditary testing. This has happened more than once.

Another reason for the somatic test is to find out if you have any Genetic issues That could cause a problem with Pluvicto for example. Doesn’t matter whether it’s hereditary or somatic if it shows up it’s more information.

Pluvicto genetic issues
RB1, PTen, TP53 are Pluvicto resistant
ATM & BRCA work better with Pluvicto

Remember that anything a urologist/oncologist tells you that’s their opinion or interpretation, you should get a 2nd opinion on - MRI results, biopsy results, PET scan results, and treatment decisions.

So, if he says “Welp, there is nothing we can do for you,” then ask for an independent 2nd opinion.

Plus, prostate cancer diagnosis and treatment is one of self-advocacy and shared decision-making. You need to come up to speed on the nuances of the disease, your diagnosis, and appropriate treatments so that you can come back with “What about this possible treatment?”

Hi John , unfortunately I do not know much about somatic testing but I just want to tell you that there is probably plenty that they can do for you.
You had some bladder neck involvement and small breach out of a gland - right ? All nodes clear, as far as I can remember, sorry if I mixed up something.
They just probably want to make sure to choose the best way forward and clear all of that cancer once and for all.
Sending you healing vibes : )))

I had germline testing that showed no mutations. I also got a foundation one test that showed some BRCA2 mutations. So it was different. My MO said no change to my treatment at this time. It can however help to direct treatment depending on the test results, patient diagnosis and stage.

Results of my Foundation One test were a driving factor in beginning immediate doublet therapy prior to EBRT. A couple of uh-oh mutations showed up. (actually 1 uh-oh, and 1 what the hell is that doing there?)

Thanks Surfer, and you do remember correctly. Also cribriform, IDPC and Gleason 4+5=9. I’m hoping that Firmagon and radiation will help now that I have my prostate out, I have an PSMA pet scan tomorrow and my psa is creeping up at 1.52. Also hoping for no more bad news! 😉

Somatic findings don’t always stay around, You could have BRCA2 Show up in your somatic test today, a year from now, it might not be there.

The thing is, if it still Shows you have somatic BRCA2 When your current treatment fails, you could start on a PARP Inhibitor.

My GU oncologist has been working with me for about eight years. Even though I am BRCA2 She has had me take other drugs before the PARP inhibitor. It has major side effects so she wants me to avoid it until it is essential. When Darolutamide fails me I will go on a PARP inhibitor.

So what your doctor said makes perfect sense.

Maybe ask about doublet therapy as @mjp0512 is having. All those negative findings may indicate the need for a more aggressive approach.