Barriers to germline genetic testing in advanced prostate cancer: Survey results from the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium (PCCTC).
Year: 2025
Type: article
Study design: Observational Study
Abstract: e17073 Background: The NCCN began recommending germline genetic testing for individuals with high-risk or advanced prostate cancer (PCa) in 2017. In 2019, our survey of physicians within the PCCTC showed that the adoption of germline testing was not widespread: 62% of physicians considered testing for all men with metastatic PCa (mPCa) and 12% considered testing for men with high risk localized PCa. In 2024 we conducted a follow up survey to evaluate changes in perception of germline testing uptake, clinic workflow and barriers. Methods: A 22-item survey was distributed via email to physicians associated with the PCCTC and was open for responses between 5/24/2024 and 7/11/2024. We collected data on physicians’ personal practices around germline testing in PCa, perceived barriers to testing and uptake of the testing. Results: 379 physicians received the germline genetic testing current practice survey, and 90 (24%) completed the survey. A total of 40% (36/90) of participating physicians reported that they refer eligible patients to a separate department for genetic testing and counseling, and more than half (70%) reported taking personal responsibility for some or all genetic education and testing of their eligible patients. 21% (19/90) reported obtaining genetic testing results through patient enrollment in a research study. When asked for a best estimate of all PCa patients who meet current NCCN criteria for germline testing who have completed testing, 28% (22/80) of physicians responded with a range of 51-75%. The remaining responses of participating physicians are split with 26% estimating >76%, 25% estimating 26-50%, and 21% estimating <26% of patients who qualify receive germline genetic testing. The majority of responders reported considering some mPCa patients for germline genetic testing: 81% reported considering all mPCa patients; 34% considered testing mPCa patients with a family history, and 38% considered testing only those for whom results would influence treatment (FDA-approved targeted therapy or trial candidates). More than half of the participating physicians (54%) considered germline genetic testing for some PCa patients with high-risk localized PCa. Based on participant responses and free text comments, cited barriers in streamlining genetic testing were: clinical workflow, time and space availability, access to genetic counselors, out of pocket cost, insurance coverage, access to resources for provider/patient education, among others. Conclusions: Physician uptake of germline genetic testing has increased since our initial survey in 2019. A greater percentage of participating physicians report ordering germline testing in their clinic and providing pre- and post-test counseling. Clinic flow and access to genetic counselors remain prominent barriers.
Source: Journal of Clinical Oncology
Authors: Alexandra Sokolova, Channing Judith Paller, Emmanuel S. Antonarakis, Pedro C. Barata, Jacob E Berchuck, Burcu Darst, Veda N. Giri, Rossella Graffeo, Feighanne Hathaway, Daniel H. Kwon, Stacy Loeb, Rana R. McKay, Zachery R. Reichert, Maria J. A. Ribeiro, Ashwin Sachdeva, Walter Stadler, Mark N Stein, Mary-Ellen Taplin, Emily Steinberger Weg, Heather H. Cheng
Institutions: Oregon Health & Science University, Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, University of Minnesota, Masonic Cancer Center, Case Western Reserve University, Dana-Farber Cancer Institute, Fred Hutch Cancer Center, Yale Cancer Center, Istituto Oncologico della Svizzera Italiana, University of Chicago, University of California, San Francisco, NYU Langone Health, University of California San Diego, University of Michigan, Atlanta VA Medical Center, University of Manchester, Columbia University Irving Medical Center, University of Washington
Language: English
Subfield: Genetics
Domain: Life Sciences
Open Access status: bronze
Funder: Prostate Cancer Foundation
OpenAlex ID: W4410809259