Point-of-care program boosts genetic testing for prostate cancer

Certain prostate cancer patients have genetic mutations that could affect how they are treated. According to a study published in Urology Practice^®, an Official Journal of the American Urological Association (AUA), a comprehensive, on-site genetic testing program developed by urologists could help close the gap for this underutilized resource. Wolters Kluwer publishes the journal under the Lippincott imprint.

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Dr Kirk Wojno, chief pathologist, and Dr Howard Korman, CEO and president of Comprehensive Urology in Royal Oak, Michigan, developed and implemented a novel algorithm to offer genetic testing to patients with newly diagnosed prostate cancer based on current recommendations.

This pathway provided a uniform avenue for our 34 urologists across 20 different locations to meet the new standard of care with regards to genetic testing, to improve patient compliance, and to enhance the overall quality of patient care.”

Dr Howard Korman, CEO and President, Comprehensive Urology, Royal Oak

Streamlined approach to detecting mutations in prostate cancer

Dr Korman’s team worked with a multidisciplinary team of medical oncologists to further enhance the provision of state-of-the-art cancer care.

Adopting a guideline-based model with on-site genetic testing improved the ability of urologists to detect germline mutations. The foresight of the urology group to partner with medical oncologists allowed us to better utilize targeted therapies, offer enrollment in clinical trials and recommend cascade testing for family members, which significantly broadened the scope of care provided to the patient and their families.”

Dr Savitha Balaraman, Oncologist, Beaumont Health

Prostate cancer has been linked to a number of clinically significant genetic mutations, including mutations linked to more aggressive malignancy and worse clinical outcomes.

Dr Korman added, “Considering the link between family history, genetic mutations, and prostate cancer, the importance of genetic testing in the diagnosis and treatment of prostate cancer cannot be overstated.”

Genetic testing, however, is still “significantly underutilized” for patients with prostate cancer. The absence of a reliable protocol to alert doctors when genetic testing and counseling may be necessary is a significant contributing factor.

Initially, patients had to travel to a different facility for genetic testing, which was done at the treating urologist’s discretion in the study clinic.

Genetic testing protocol triples rate of patient compliance

The extensive genetic testing protocol was implemented by the researchers at their considerable urology practice in 2018.

Patients were advised to undergo testing to find mutations linked to prostate cancer in accordance with National Comprehensive Cancer Network recommendations based on a variety of factors, including a family history of the disease, hereditary breast or ovarian cancer, and Ashkenazi Jewish ancestry.

Testing was done during routine clinic visits, and the patient’s urologist or other medical professionals provided genetic counseling as needed.

The new workflow significantly increased the number of patients receiving genetic testing, even though the clinic’s annual patient volume stayed about the same. In comparison to 78 patients before the practice change, 474 patients had testing recommended after the introduction of the protocol based on guidelines.

The new protocol increased patient compliance with advised genetic testing by about three times, from 33.3% to 98.7%. The turnaround time for genetic test results was also shortened by point-of-care testing, going from 38 to 21 days.

Dr Korman concluded, “Given the growing importance of genetic testing in the management of prostate cancer, these results present a solution to bolster the implementation of genetic testing in urology practices.”

The new testing workflow’s ability to identify different mutation types will be covered in a future report by the authors. The researchers discuss the difficulties in using genetic testing for prostate cancer more widely, such as concerns about costs and insurance coverage, and emphasize the need for larger studies to confirm their findings.