Archive tumour genomic sequencing test advice needed.

[Brysonal]

After moving into APC at the start of 2021 with two mets at T1 and third rib I saw progression to 6 more tumours on the spine following an attempt at SBRT which reduced these two mets but failed to prevent the new ones. This led to my RO passing me to an MO and my starting a systemic triplet with PSA rising quite rapidly to 17.4.

Degarelix - started 25th November 2021

Early Lu-177 ( off licience) 2 infusions with third planned for 10th Feb

Abiraterone not started yet

My PSA is now 0.79 but no PSMA scan yet.

My question is regards genomics as my dad died on PCa so I had full consult / germ line blood test for 80 defects that came back negative. The genetics professor recommended a sequence test of the archive biopsy held by by diagnosing surgeon but didn’t say which test

My diagnosing surgeon is asking me which one. The genetics professor is difficult to get hold of. Can anyone advise which test on the archive tumour is best?

Just trying to get all facts in case!

Thank you all

[tango65]

I used Foundation One for the study of the primary tumor. However, when there is metastatic disease, the metastases may have a different genome than the primary tumor. You could discuss having a direct biopsy or if a liquid biopsy is possible and consult with Foundation One about their somatic tests for PC.

[Brysonal in reply to tango65]

Thank you

I’m not sure mid Lu-177 what I’ll have to biopsy. I was advised against having my T1/ rib mets biopsied and just went straight to SBRT. In Nov a prostate biopsy was planned but abandoned due to the HIFU leaving a hard shell so I just have my archives from 2016 original biopsy at diagnosis and 2019 reoccurrence diagnosis ( I had three focal treatments to the primary) I have had a CfDNA test but no idea what it showed! Will chase that up and research foundation one. I know my RO did genetics under the professor when she trained and was happy to tell me how they go about it but no progress on getting it done I thought I’d go straight to my biopsy surgeon to ask for it done and just get brick wall replies. Probs need to pay for a second consult with genetics professor and take better notes this time! It’s all so disjointed here in the uk!

[Brysonal in reply to Brysonal]

Ah this one as you says sounds like it. Maybe just directly ask her to get this one done

foundationmedicine.com/test...

Thank you

[tango65 in reply to Brysonal]

Best of luck!

[Brysonal in reply to tango65]

Thank you!

[Tall_Allen]

When you say "archive tumor," was the tumor from a prostate biopsy or a metastasis? If prostate, it might have been Decipher, Oncotype Dx, or Prolaris. If from a metastasis, it might have been Foundation One, orl, it may have been a research project from the hospital.

[dhccpa in reply to Tall_Allen]

TA are those tests covered by Medicare for patients with three or more bone metastases? Thanks

[Tall_Allen in reply to dhccpa]

Get pre-authorization - they are very expensive.

[dhccpa in reply to Tall_Allen]

Thanks. My MO seems confused on how to order my prostate biopsy samples. I've never asked him about biopsying a bone met.

[Brysonal in reply to Tall_Allen]

I have two archive tumours both from the prostate cancer in the prostate. I was advised against having my bone mets biopsied and so have nothing archived or otherwise. maybe should have insisted before allowing treatment to start, but the original mets both had SBRT and all newbies getting Lu-177 ( and i'm on degarelix now). Strange oncos don't seem clued up here