First genetic testing, it’s funny doctors don’t explain this to you...what do you think?

[5_plus_4]

01/28/2021

Message body: I have already done genetic studies on your tumor and I will look into germline testing next week.

Your PSA remains undetectable PSA <0.1 01/21/2021

PSA <0.1 12/22/2020

PSA <0.1 10/30/2020

The specimen met all input requirements.

The sequencing data passed all quality control assessments.

See Note.

Genomic Findings Associated Therapies

KRAS p.Q61H

NM_033360.3:c.183A>T

Estimated variant allele frequency: 17%

Standard of care biomarkers with no reportable alterations: N/A

Not eligible for NCI-MATCH - Exclusionary alteration present

Not eligible for Strata Trials - Exclusionary alteration present

Biomarker Findings Associated Therapies

MSS

Microsatellite Stable

Sequencing quality was insufficient for TMB assessment

1/2/L denotes line of therapy (first, second, later) indicated per FDA-approved drug label or recommended per NCCN guideline

for patient's tumor type. * indicates preferred therapy, ^ indicates emerging evidence, M indicates maintenance per NCCN

guideline. NCI-MATCH and Strata Trial Match indicate therapies available through partnered clinical trials.

Note

The tumor content was less than 40%, precluding detection of deep deletions.

Physician Information Specimen Information

Client Kaiser Permanente Sherman Way Histology Date of Collection 02/12/2018

Ordering Physician AMINU BIRHAN Date Received 12/11/2020

[DenDoc]

I don't think most of us are capable of reading and understanding this descriptive report which the Kaiser system generated. It needs to be interpreted by your treating physician. I suspect there is more to this than the lab report with some suggestions for further therapy. When I got my report back it was 24 pages long. Though I am a 79 year old retired physician I thought I was reading a foreign language.

My Kaiser oncologist (a person less than half my age and recently trained) summarized it and shared his treatment plans based on the genetic studies.

I think your doc is heading in that direction. You need an interpretation, not a report. I love the electronic record access but sometimes I would rather wait for his interpretations of my scans, etc.

Hope you can get that all straightened out and that you can trust the care that you are getting. When I started this path 25 years ago there was no hint of such sophisticated care for prostate cancer. To me it is a miracle despite being in the club I had never hoped to join.

[maley2711 in reply to DenDoc]

Why did you, an informed MD, choose Kaiser as your insurer and medical provider? I assume a Medicare Advantage plan? I wll soon need to make a choice on Medicare coverages. My wife works at Kaiser, and I like a number of things about their system, but with concern about PCa, I'm concerned about choice at Kaiser? After an MRI found a concerning PIRADS lesion, a referral for outside fusion biopsy was denied.....Kaiser doesn't have the fusion equipment. With no guidance as to what would be needed, but with my Kaiser MD telling me the best option would be the fusion biopsy( he could do a cognitive, but ????), I decided to jump in head first, spent a number of months preparing a 100 page appeal, including 25 studies re fusion biopsy.....fially the fusion biopsy was approved. Then the local med school reread my mRI, and told me it was MUCH more troubling than Kaiser had indicated!!

comments Doc?

[DenDoc in reply to maley2711]

I am a retired pediatrician at Kaiser in Denver. It is a totally paid benefit for me and is by far the best choice in Colorado for organized care. I only once went outside the system for a second opinion at the University. After that KP oncologists were open to the recommendation and we have stayed in the system for everything. Things are changing so dramatically in Oncology that I was upset when my original oncologist retired. My wife correctly pointed out that a young, newly trained oncologist would bring more to the table. He is a wonderful, kind and compassionate man who has seen me through some very dark days. My daughter is a KP pediatrician now and since I was here from the start-up days I am very happy with my care.

[maley2711 in reply to DenDoc]

Thanks Doc!! I guess from your answer, you don't view it as a big deal that coverage for non-Kaiser specialists and treatments is generally not covered? Eg, Viewray real-time MRI monitoring radiation equipment is now available at our Providence system, but unlikely Kaiser would cover? I'd probably be told.....Kaiser radiation equipment is sufficient.

In no way am I complaining about the Kaiser Docs as a group......usually we're very happy!! the easy communication between Docs is also a big plus....though systems are improving so that communication between outside Docs is now much easier also.