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UPJ INSIGHT: Comprehensive Genetic Testing Protocol for Prostate Cancer Patients in a Uro-oncology Practice
By: Siddharth Ramanathan, BS (Hons); Andrew Korman, BS; Sadhna Ramanathan, BS; Howard Korman, MD; Michael I. Ghilezan, MD, PhD; Michael Levin, MD; Kirk Wojno, MD; Alvaro Martinez, MD; Savitha Balaraman, MD | Posted on: 04 Jan 2023
Ramanathan S, Korman A, Ramanathan S, et al. Positive impact of implementing a comprehensive genetic testing protocol for prostate cancer patients in a multi-disciplinary uro-oncology practice. Urol Pract. 2023;10(1);33-39.
Study Need and Importance
The 2017 Philadelphia Consensus Conference significantly expanded the indications for genetic testing. However, there remained a lack of clear recommendations regarding the implementation of genetic testing for prostate cancer patients. While the updated 2019 conference guidelines addressed the delivery of genetic testing by endorsing point-of-care testing, there remains a critical lack of literature concerning the successful deployment of a genetic testing pathway for prostate cancer patients. In this study we aim to evaluate an on-site, guideline-based point-of-care genetic testing process for prostate cancer patients in our practice.
What We Found
We observed a stark, statistically significant increase in compliance with genetic testing from 34% to nearly 99% after the implementation of this genetic testing workflow. We also noted a similar improvement in patient compliance with post-test genetic counseling, which increased from 0% to 60%. Additionally, we found a marked increase in referral for genetic testing, from 78 patients to 474 patients after the implementation of on-site guideline-based genetic testing without a significant change in the underlying practice volume (see Table).
Limitations
Considering that randomization was not conducted, the study design certainly introduces a potential source of bias. Additionally, the smaller sample size of patients recommended for genetic testing prior to the implementation of this workflow may potentially be another source of bias. Furthermore, the small sample size of patients who complied with post-test counseling limits an interpretation of the effect of this process on patient compliance with genetic counseling. We also do not possess robust estimates for the total number of patients who ought to have received genetic testing prior to the introduction of guideline-based genetic testing.
Table. Compliance With Genetic Testing and Subsequent Follow-up
| Off-site testing | On-site guideline-based testing | P value | |
|---|---|---|---|
| Count, No. | 78 | 474 | – |
| Compliance with genetic testing, No. (%) | 26 (33.3) | 468 (98.7) | < .0001 |
| Compliance with follow-up visit, No. (%) | 0 (0.0) | 262 (60.0) | < .0001 |
| Turnaround time, d | 38 | 21 | < .0001 |
Interpretations for Patient Care
Nonetheless, our results underscore the importance of a comprehensive model for effectively delivering genetic testing and genetic counseling to prostate cancer patients. Considering the fundamental importance of genetic testing in the uro-oncological management of prostate cancer, this study presents a unique and significant contribution to the literature by outlining a successful model for providing genetic testing to prostate cancer patients.
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