• Ravindran Kanesvaran, Puey Ling Chia, Edmund Chiong, ChuaMelvin Lee KiangMLKDivision of Radiation Oncology, National Cancer Centre Singapore, Singapore., Nye Thane Ngo, Samuel Ow, Hong Gee Sim, Min-Han Tan, Kiang Hiong Tay, WongAlvin Seng CheongASCDepartment of Haematology-Oncology, National University Cancer Institute, Singapore., Siew Wei Wong, and Puay Hoon Tan.
• Division of Medical Oncology, National Cancer Centre Singapore, Singapore.
• Ann Acad Med Singap. 2023 Mar 30; 52 (3): 135148135-148.

IntroductionThere has been a rapid evolution in the treatment strategies for metastatic castration-resistant prostate cancer (mCRPC) following the identification of targetable mutations, making genetic testing essential for patient selection. Although several international guidelines recommend genetic testing for patients with mCRPC, there is a lack of locally endorsed clinical practice guidelines in Singapore.MethodA multidisciplinary specialist panel with representation from medical and radiation oncology, urology, pathology, interventional radiology, and medical genetics discussed the challenges associated with patient selection, genetic counselling and sample processing in mCRPC.ResultsA clinical model for incorporating genetic testing into routine clinical practice in Singapore was formulated. Tumour testing with an assay that is able to detect both somatic and germline mutations should be utilised. The panel also recommended the "mainstreaming" approach for genetic counselling in which pre-test counselling is conducted by the managing clinician and post-test discussion with a genetic counsellor, to alleviate the bottlenecks at genetic counselling stage in Singapore. The need for training of clinicians to provide pre-test genetic counselling and educating the laboratory personnel for appropriate sample processing that facilitates downstream genetic testing was recognised. Molecular tumour boards and multidisciplinary discussions are recommended to guide therapeutic decisions in mCRPC. The panel also highlighted the issue of reimbursement for genetic testing to reduce patient-borne costs and increase the reach of genetic testing among this patient population.ConclusionThis article aims to provide strategic and implementable recommendations to overcome the challenges in genetic testing for patients with mCRPC in Singapore.

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