Transforming genomic testing in prostate cancer: A comprehensive system-wide initiative.

Abstract

11139 Background: Timely detection of pathogenic variants enables personalized treatment and improved outcomes in prostate cancer (PC). In 2020, NCCN guidelines recommended genomic testing for mPC, but by 2022, only 30.8% of mPC patients in Florida had undergone appropriate testing. In our current study, we evaluate the impact of system-wide quality improvements at SCCC on genomic testing rates for mPC patients. Methods: In alignment with NCCN guidelines, several initiatives were launched in 2023 to enhance adherence to genomic testing practices. In May 2024, SCCC partnered with Florida Society of Clinical Oncology (FLASCO) and Pfizer on a state-wide initiative to address barriers to germline testing. A survey was conducted to assess the genomic testing process and identify gaps in adherence. System improvement projects were initiated, accompanied by efforts to raise awareness. A retrospective analysis utilizing EPIC Electronic medical record (EMR) data evaluated genomic testing rates among patients with newly identified mPC at SCCC from 2022 to 2024, stratified by ethnicity. Results: In 2022, baseline genomic testing rates for mPC at SCCC were 57%. Starting in 2023, high-risk cancer screening programs and EMR-focused initiatives, including the Genomics Module and Invitae integration, centralized molecular results and established registry to track alterations. In 2024, the survey revealed that 50% of physicians received unstructured genomic testing results via EMR, while 83.3% faced challenges accessing results for decision-making. Drawing from the successful breast cancer screening program, multidisciplinary teams were formed to address gaps and enhance testing adherence, focusing on awareness and enhancing EMR integration, reporting, and health prompts. That year, genomic results integration into the data portal also began. Using Slicer Dicer and Epic reporting, we evaluated testing rates, which improved to 68.6% in 2023 and 74% in 2024, with Hispanic patients achieving 76.5% and 80%, respectively. Conclusions: Institutional initiatives at SCCC, including expanding the Genetics program and enhancements to EMR functionality, have successfully increased genomic testing rates for mPC patients across all ethnicities. Building on this progress, approved steps for 2025 include expanding the integration of molecular testing with additional testing vendors, creating a dedicated Molecular tab with discrete fields in the EMR, and expanding education and training programs to further streamline genomic testing practices. Year Testing Rate Hispanic Initiatives 2022 57% 50% – 2023 68.6% 76.5% Jan – High Risk Screening ClinicFeb – Genetic Predisposition Syndrome ClinicOct – Invite integrationOct – Epic Genomics Module 2024 74% 80% May – mPC Testing Workflow assessedSep – SCCC data portal- molecular testing results integrationOct – Multidisciplinary team to identify gaps and prioritize projects