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).

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.