JU INSIGHT Clinical Impact of a Rapid Genetic Testing Model for Advanced Prostate Cancer Patients

By: Kelsey E. Breen, MS, MSc, Memorial Sloan Kettering Cancer Center, New York, New York; Heather Symecko, MPH, Basser Center for BRCA, University of Pennsylvania, Philadelphia; Kelsey Spielman, MS, Basser Center for BRCA, University of Pennsylvania, Philadelphia; Rebecca Gebert, BA, Memorial Sloan Kettering Cancer Center, New York, New York; Ibrahim H. Shah, BA, Memorial Sloan Kettering Cancer Center, New York, New York; Stacy Pundock, MPH, Basser Center for BRCA, University of Pennsylvania, Philadelphia; Melissa Batson, MPH, Basser Center for BRCA, University of Pennsylvania, Philadelphia; Vivek K. Narayan, MD, Hospital of the University of Pennsylvania, Philadelphia; Zsofia K. Stadler, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Karen A. Autio, MD, MSc, Memorial Sloan Kettering Cancer Center, New York, New York; Wassim Abida, MD, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Daniel C. Danila, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Howard I. Scher, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Michael J. Morris, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Jada G. Hamilton, PhD, MPH, Memorial Sloan Kettering Cancer Center, New York, New York; Mark E. Robson, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Susan M. Domchek, MD, Basser Center for BRCA, University of Pennsylvania, Philadelphia; Maria I. Carlo, MD, Memorial Sloan Kettering Cancer Center, New York, New York | Posted on: 18 May 2023

Breen KE, Symecko H, Spielman K, et al. Clinical impact of a rapid genetic testing model for advanced prostate cancer patients. J Urol. 2023;209(5):918-927.

Study Need and Importance

Patients with advanced prostate cancer are recommended to undergo germline genetic testing to determine eligibility for certain treatments, such as poly(ADP-ribose) polymerase (PARP) inhibitors. To expedite the genetic testing process and expand access for these patients, this study aimed to determine the feasibility and clinical impact of an alternative hereditary genetic testing model for individuals with advanced prostate cancer.

What We Found

Germline genetic testing initiated in the oncology clinic with post-test counseling by a genetic counselor is a feasible approach to testing patients with advanced prostate cancer. Of the 501 participants in the study, approximately 10% harbored a pathogenic variant in a cancer predisposition gene, leading to a discussion of change of treatment for 46% of those individuals. Results typically were provided to participants within 3 weeks after sample collection, and participants were highly satisfied with the pretest education and the decision to undergo genetic testing.

Limitations

We acknowledge a possible selection bias toward individuals with strong family histories or aggressive, early-onset prostate cancer. Additionally, not all participants completed the questionnaires, and one of the measures on the questionnaires was investigator-designed and unvalidated.

Interpretation for Patient Care

There are a growing number of patients who will undergo germline genetic testing as part of their clinical care considering the U.S. Food and Drug Administration approval of therapeutics, such as PARP inhibitors. We present and provide the materials for a model of oncologist-initiated genetic testing with post-test results provided by a genetic counselor who can provide efficient yet comprehensive care without sacrificing patient satisfaction or education.