Metastatic Prostate Cancer Testing Costs and Benefits
- Germline testing for inherited mutations in metastatic prostate cancer is always recommended and typically involves consultation with a genetic counselor and a saliva test which is often covered by insurance but can cost up to $250 out of pocket.
- There is no strict timeline to perform germline testing; it can be scheduled at your convenience.
- Germline testing, although often negative for inherited DNA mutations, provides benefits by giving your family peace of mind if it is negative for inherited mutations.
- If germline testing is positive, it allows other family members to test and take appropriate steps to undergo early screening and detection for certain cancers. It can also provide information on targetable DNA mutations with cancer treatments.
- Somatic Testing of the tumor can be performed on the initial biopsy, repeat biopsy of metastatic disease, or with liquid biopsy with blood.
- Somatic testing of the tumor is often more expensive and can cost thousands of dollars. The coverage is variable and depends on your insurance provider and disease status. The information gathered typically informs treatment decisions later in the disease course. It is important to discuss insurance coverage with your healthcare team.
- Testing for somatic mutations allows patients to avoid therapies that are ineffective, add additional costs, and have side effects. If positive for specific mutations, it can potentially assist in enrollment in clinical trials and selecting additional targeted therapies.
Current national guidelines recommend that anybody diagnosed with metastatic prostate cancer should undergo genetic testing. When discussing prostate cancer as genetic or molecular testing, there are two main categories, germline and somatic tumor testing. The costs and benefits of these tests vary; understanding both options is important when making informed decisions with your healthcare team.
Germline Testing
Read MoreGermline Testing – The Costs
With relatively low rates of germline mutations even among higher-risk prostate cancers, what is the cost of this testing? If present, these germline mutations are in every cell in your body and can therefore be tested by collecting a blood or saliva test rather than tissue from the cancer itself. Germline testing following a diagnosis of metastatic prostate cancer typically involves meeting with a genetic counselor and a test using your saliva. “The germline testing is often fairly cheap, around $250,” says Dr. Michael Carducci, a medical oncologist focused on prostate cancer research at Johns Hopkins Kimmel Cancer Center.Because it does not require invasive testing (as opposed to prostate biopsy), there are no additional costs associated with a procedure. Additionally, germline genetic testing can be scheduled at your convenience. Any decision that would be made because of a positive result typically comes much later in treatment after other therapies for metastatic prostate cancer have been used. “Patients can order it on their own. We can schedule it. We just want to make sure we see the data,” says Dr. Carducci.
Germline Testing – The Benefits
The germline test is beneficial for several reasons:
- If negative, it gives other family members peace of mind that they do not carry a genetic mutation and the associated increased risk of cancer.
- If positive, it allows other family members the option to also test and take the appropriate steps to protect themselves in the future.
- Certain germline mutations have targeted therapies available, which can be used later in the treatment of prostate cancer.
If germline testing is positive, or you are found to have an inherited gene that puts you at an increased risk of developing cancer, it can mean several things. Other related family members are recommended to undergo germline genetic testing as well. Each known inherited genetic mutation carries a risk of developing cancer in specific organs. If someone without cancer is found to have an inherited gene, further testing and surveillance can be recommended. With improved testing and surveillance, potential cancers can be caught in earlier stages, and available treatments can be more effective at curing the disease, ultimately leading to decreased costs down the road.
For example, men with BRCA1 or BRCA2 mutations are at an increased risk of developing prostate cancer. These mutations are also known to increase the risk of various cancers including breast, pancreatic, and ovarian cancer.
Somatic Tumor Testing
Somatic mutation testing looks for changes in the DNA of the tumor itself. Somatic mutations are not inherited from parents and typically occur spontaneously in the cancer cells. As opposed to germline testing, which can be done from a saliva test and uses normal cells in your body, somatic testing requires pieces of the cancer cells and is usually done on a sample of tissue obtained from a tumor biopsy.
These can be obtained in multiple ways, most commonly from the first prostate cancer biopsy, which is required in the initial diagnosis and workup of your prostate cancer. If the cancer is believed to have changed and potentially acquired new mutations since initial diagnosis and biopsy, somatic testing can be performed with repeat tissue biopsy or can be performed with liquid biopsy, where a blood test is performed to analyze a piece of circulating tumor cells, or circulating tumor DNA (ctDNA). When somatic testing of the tumor is performed, it can also uncover potential germline mutations. If this is the case, additional germline testing is typically performed if it has not already been completed.
Somatic Tumor Testing – The Costs
Several molecular tests and next-generation sequencing tests are available to analyze the prostate cancer DNA and look for a variety of mutations within the prostate cancer itself. These tests are often expensive, sometimes costing thousands of dollars. These tests are often covered by Medicare and private insurance. However, coverage is variable. Although the cost of NGS continues to decline and insurance coverage for molecular testing improves, it is important to discuss insurance coverage and the potential need for prior authorization (pre-approval from the insurance company) of these tests with your healthcare team.
In addition to cost, the number of actionable mutations in prostate cancers is relatively low at around 20%. This means in about 20% of cases, somatic tumor testing identifies a change in the prostate cancer DNA that can be acted upon and change treatment decisions.
Somatic Testing Seems Expensive, And Likely Has a Negative Result. What Is The Benefit To Me?
When a new diagnosis of metastatic prostate cancer is made, several non-specific treatment options are typically available, often utilizing hormone therapy. “With new diagnosed metastatic disease, we’re not adding in these drugs that target mutations. Those are often used later,” says Dr. Carducci. This means that more specific molecular testing of somatic mutations of the cancer cells is not often necessary in the early stages of a metastatic prostate cancer diagnosis as you can initially be treated with hormone therapy which is often effective.
In fact, most indications for approval for targeted therapies in metastatic prostate cancer come when prostate cancer has figured out how to bypass hormone therapies. When prostate cancer is no longer responding to hormone therapies, and your testosterone level remains suppressed, this is called castration resistant prostate cancer. It is in this setting (the castration resistant setting) that other therapies, such as targeted therapies, are more commonly used. This means targeted therapies are usually not covered by insurance until hormone therapy has stopped working.
The benefit of testing for somatic mutations is that when the results are positive in about 20% of patients with metastatic disease, patients can then be eligible for more effective targeted therapies and potential enrollment in ongoing clinical trials. Additionally, if this testing is negative, your healthcare team can avoid using drugs that do not work, add additional cost, and have their own side effects.
Learn more about SurvivorNet's rigorous medical review process.
