Articles

Practical guidance for molecular testing in metastatic prostate cancer: A Belgian perspective

BJMO - volume 16, issue 7, november 2022

S. Verbeke MD, PhD, S. Verschuere MD, PhD, M-D. Martín-Martinez MD, B. Lelie MD, L. Libbrecht MD, PhD, M. Baldewijns MD, PhD, S. Rorive MD, PhD, G. Beniuga MD, J. Eben MD, M-A. van Caillie MD, N. D’Haene MD, PhD, C. Gabriel MD, F. Dedeurwaerdere MD, Ir A. Hébrant PhD, H.L. Gijs , K.B.M. Claes PhD, D. De Maeseneer MD, B. Tombal MD, PhD, P. Pauwels MD, PhD

SUMMARY

The recent approval of the poly(ADP-ribose) polymerase (PARP) inhibitor olaparib for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) harbouring pathogenic variants of BRCA2 or BRCA1 marks the start of molecularly guided precision medicine in prostate cancer. In parallel with this approval comes the need to embed molecular diagnostics in the clinical management of patients with mCRPC. To date, however, there are no established protocols in Belgium for the use of mutation testing in this setting. This article will therefore provide practical guidance for sample preparation and handling, pre-analytic processing, and pathogenic variant analysis in mCRPC. Across the different phases of this process, a multidisciplinary approach involving urologists, oncologists, radiologists, pathologists, molecular biologists, technicians, nurses, and geneticists will be key to safeguard adequate sample selection to perform molecular analyses at the time of metastatic disease. It will also facilitate high-quality molecular testing with a minimal failure rate. Only by optimising this process will physicians be able to adequately select mCRPC patients that are most likely to benefit from PARP inhibition, or other future targeted therapies, allowing to use these agents in the correct patient groups.

(BELG J MED ONCOL 2022;16(7):343–54)

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Belgian consensus guidelines for prostate core needle biopsy reporting

BJMO - volume 12, issue 6, october 2018

T. Gevaert MD, PhD, L. Libbrecht MD, PhD, E. Lerut MD, PhD, B. Weynand MD, PhD, M. Lammens MD, PhD, S. Verschuere MD, PhD, C. Mattelaer MD, B. Lelie MD, J. Eben MD, L. Martinez , M-A. van Caillie MD, S. Rorive MD, PhD, S. Verbeke MD, PhD, M. Baldewijns MD, PhD

The Belgian Working Group on Uropathology has agreed upon a dataset for prostate core needle biopsy reporting, based on existing international guidelines, recent scientific insights, national survey analysis and panel discussion, with the focus on a user- and receptor-friendly format. This dataset should encourage standardised structured reporting of prostate biopsies in the Belgian healthcare system, aiming to improve the quality of individual pathology reports and to provide real benefit for the clinical management of patients and secondary users. Therefore the Belgian Working Group on Uropathology recommends implementing this dataset in each Belgian pathology lab, in close consultation with the entire clinical team involved in the treatment of the prostate cancer patient.

(BELG J MED ONCOL 2018;12(6):279–286)

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Changes in the periductal stroma of ductal carcinoma in situ (DCIS) of the breast yield potential biomarkers for recurrence risk prediction

BJMO - volume 9, issue 7, december 2015

M. Van Bockstal MD, PhD, L. Libbrecht MD, PhD

Summary

Ductal carcinoma in situ is regarded as a non-obligate pre-invasive precursor of invasive ductal carcinoma. Up to one in four patients will recur locally after breast-conserving surgery alone, and approximately half of these recurrences will be invasive. Recurrence prediction is still not satisfactorily accurate and could be improved by identifying additional prognostic markers.

As the role of the tumour microenvironment in cancer progression is increasingly acknowledged, this PhD research project aimed to explore the prognostic potential of stromal features in ductal carcinoma in situ. The presence of periductal myxoid stroma was identified as an adverse prognostic factor for both overall and invasive recurrence risk. This myxoid stromal architecture correlated with reduced stromal decorin expression and increased periductal versican expression. The cytokines bFGF and TGF-β1 were identified as potent modulators of stromal protein expression. We hypothesise that certain preinvasive ductal carcinoma in situ lesions modulate the composition of their surrounding stroma through cytokine release. This invasion-permissive and tumour-promoting microenvironment is mirrored in the presence of a myxoid stromal architecture. Further studies are required to validate the value of stromal changes as prognostic markers for recurrence in ductal carcinoma in situ.

(BELG J MED ONCOL 2015;9(7):296–98)

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