Every year, in Italy, about 7 thousand men are diagnosed with a severe form of prostate cancer, metastatic cancer, ie in which the cancer has already spread to other organs. And about 12% of these patients – almost a thousand people a year – have a mutation in the BRCA genes, those used to regulate DNA repair mechanisms, similar to that associated with the onset of breast and ovarian cancers. A help for these patients comes from precision medicine, and in particular from the possibility of researching the mutation on tissue taken with a biopsy or with a blood test: with these diagnostic tools it is in fact possible to select the most appropriate therapy and extend screening to family members if the gene mutation is inherited. This is what emerged today during the XXXII National Congress of the Italian Society of Oncological Urology (SIUrO): alongside the possibilities offered by precision medicine, the experts also underlined the current lack, in our country, of a network of certified laboratories in able to carry out tests, the results of which arrive, among other things, in too long a time.
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“Genetic counseling – explained Alberto Lapini, former SIUrO national president, opening the event dedicated to current opportunities and limits of precision medicine – has great potential in uro-oncology: we should propose the execution of the BRCA test to all patients with metastatic prostate cancer to evaluate the possibility of using, when indicated, an individualized therapy “. The benefits of performing this test are two: for therapy (in the patient), because the characterization of the tumor can help to choose the best treatment, and for prevention (in family members), in the event that the mutation is hereditary type: “If the alteration found is of the germinal type – continues Lapini – there is a fair probability that the gene is also present in other components of the family unit: the search for the mutation of BRCA genes in family members can allow to identify other cases cancer of the prostate but also of the breast, ovary or pancreas “.
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However, having the right tools is not enough: you must also use them appropriately and above all make sure that all patients can benefit from them equally. And this, the experts say, is the challenge still to be faced: “The current limits of precision medicine – explains Sergio Bracarda, who is now the new SIUrO president – are not scientific, but above all of a bureaucratic and administrative nature. The laboratories that carry out these tests are not uniformly present throughout the national territory. All those operating should also respect some minimum parameters and quality paths. This is the only way to create a network of centers that is efficient and sustainable also from an economic point of view ”. All the more so if we take into account the fact that identifying mutations of this type can mean anticipating the onset of the disease in relatives, with a considerable saving in terms of treatments.
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However, the path seems to be the right one, especially in virtue of the latest treatment options offered by technology: “In recent years, the quality of life of patients has greatly improved thanks to technological advances in the field of radiotherapy and surgery, and in particular with minimally invasive robotic surgery – says Rolando D’Angelillo, professor of radiotherapy at the University of Rome Tor Vergata – Fortunately, thanks to the PNRR, in recent years we have been able to spread these technological tools more evenly throughout Italy and reduce disparities geographical in the treatment “.