In this episode, Dr. Aditya Bagrodia speaks with Dr. Todd Morgan about the clinical role of germline testing in prostate cancer—who should receive testing, when to order it, and how results inform care. They clarify the distinction between germline, molecular, and genomic testing, underscoring how inherited DNA mutations can guide early cancer screening for patients and their families. With up to 12% of metastatic prostate cancer and 5–10% of localized disease linked to inherited alterations, both experts emphasize thorough family history as a key trigger for testing, alongside universal testing for metastatic disease.
The conversation explores how specific mutations, particularly BRCA2, may influence management decisions—from considering earlier treatment in select low-risk patients to implementing intensified screening strategies (such as lower PSA thresholds, urine biomarkers, and MRI) for high-risk but undiagnosed individuals. Dr. Morgan highlights the importance of thoughtful test selection, the limitations of direct-to-consumer tests like 23andMe, and the responsibility clinicians have in delivering results and coordinating genetic counseling. The episode concludes with a look at ongoing clinical trials and research aimed at refining how germline insights shape prostate cancer management.
Contributors:
Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.
Dr. Todd Morgan is the chief of urologic oncology at the University of Michigan.
