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Clin Genitourin Cancer. 2019 Aug;17(4):275-282.e1. doi: 10.1016/j.clgc.2019.04.013. Epub 2019 Apr 18.

Germline Genetic Testing in Advanced Prostate Cancer; Practices and Barriers: Survey Results from the Germline Genetics Working Group of the Prostate Cancer Clinical Trials Consortium.

Author information

1
Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Johns Hopkins University, Baltimore, MD.
2
Division of Hematology/Medical Oncology School of Medicine, Oregon Health and Science University Knight Cancer Institute, Portland, OR.
3
Department of Medicine, University of California San Francisco/Helen Diller Family Cancer, San Francisco, CA.
4
Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY.
5
Division of Medical Oncology, Department of Medicine and Duke Cancer Institute, Duke University Medical Center, Durham, NC.
6
Division of Hematology and Medical Oncology, VA Portland Health Care System/Oregon Health & Science University Knight Cancer Institute, Portland, OR.
7
Division of Hematology, Oncology, and Transplantation, University of Minnesota Masonic Cancer Center, Minneapolis, MN.
8
Karmanos Cancer Institute and Department of Oncology, Wayne State University, Detroit, MI.
9
Fred Hutchinson Cancer Research Center and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
10
Department of Medicine, University of California at San Diego Moores Cancer Center, La Jolla, CA.
11
Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL.
12
Department of Medicine, University of Chicago Comprehensive Cancer Center, Chicago, IL.
13
Department of Urology, Yale Cancer Center, New Haven, CT.
14
Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
15
Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA.
16
Department of Medicine, Hematology/Oncology, University of North Carolina Lineberger Cancer Center, Chapel Hill, NC.
17
Prostate Cancer Clinical Trials Consortium, Memorial Sloan Kettering Cancer Center, New York, NY.
18
Fred Hutchinson Cancer Research Center and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: hhcheng@uw.edu.
19
Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA. Electronic address: Veda.Giri@jefferson.edu.

Abstract

BACKGROUND:

Germline genetic testing increasingly identifies advanced prostate cancer (PCa) patients who are candidates for precision therapies. The Prostate Cancer Clinical Trials Consortium (PCCTC) established the Germline Genetics Working Group to provide guidance and resources to expand effective use of germline genetic testing.

MATERIALS AND METHODS:

A 14-item questionnaire was e-mailed to academic oncologists at 43 PCCTC sites to collect information on germline genetic testing patterns, including patients considered, choice of assays, barriers slowing adoption, and actions to overcome barriers.

RESULTS:

Twenty-six genitourinary oncologists from 19 institutions responded. Less than 40% (10 of 26) reported referring patients to a genetics department, whereas the remainder take personal responsibility for genetic testing and counseling; 16 (62%) consider testing all metastatic PCa patients, whereas 3 (12%) consider testing all patients with high-risk local disease; and 7 (27%) use multigene comprehensive pan-cancer panels, and 14 (54%) use smaller or targeted cancer gene panels. Barriers to widespread use are: (1) delayed or limited access to genetic counseling; (2) no insurance coverage; (3) lack of effective workflows; (4) insufficient educational materials; and (5) time and space constraints in busy clinics. The primary limitation was the <50% (19 of 43) response from PCCTC sites and no coverage of nonacademic cancer treatment facilities.

CONCLUSION:

Joint efforts by urologists, oncologists, genetics counselors, insurers, and cancer centers can accelerate implementation of integrated germline genetic services for personalized treatment and clinical trial eligibility for PCa patients.

KEYWORDS:

BRCA; DNA repair; Lynch; PARP inhibitors; Pembrolizumab

PMID:
31171481
PMCID:
PMC6662206
[Available on 2020-08-01]
DOI:
10.1016/j.clgc.2019.04.013

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