(UroToday.com) Precision oncology is the increasing standard of care, both in the somatic and germline compartment, including in prostate cancer clinical practice. Professional guidelines recommend screening for hereditary cancer risk in men with prostate cancer to both inform risk of primary and subsequent cancers, as well as to influence treatment decisions (i.e. PARP inhibitors). The authors sought to evaluate the feasibility of instituting a hereditary cancer risk assessment (HCRA) protocol in their urological practice for prostate cancer patients. Objects also included evaluating the experience of HCRA in both providers and patients.
Dr. Shore and his colleagues developed a four phase prospective study as summarized below. The first phase was process integration (4 weeks) where study site staff were trained in performing HCRA. The second phase was practice of the HCRA, where staff incorporated the learned recommendations into their standard practice workflow for 4 weeks. The third phase was post-integration and allowed eligible patients to be consented to participate. These patients were at least 18 years old, had a personal history of prostate cancer, and met guidelines for germline screening (via National Comprehensive Cancer Network, 2.2018). Finally, patients and providers have completed surveys in the fourth phase (follow up) regarding testing ≥8 weeks of test delivery or 1 week of end of data collection period, respectively.
In the pre-intervention analysis, 8 weeks prior to initiation of the study, 4.2% of patients at study sites completed screening for hereditary cancer. During the study, 8.4% completed testing, representing approximately half of screened eligible patients. 19 (10.2%) of these 182 tested patients harbored a single pathogenic variant (monoallelic MUTYH [n = 4]; BRCA2 [n=3]; ATM, BRCA1, BRIP1, CHEK2, HOXB13 [n=2, for each]; RAD51C, RAD51D [n=1, for each]). Of note, not all patients with a detected pathogenic alteration had self-reported family history of cancer.
When asked during the follow up period, most providers (61.0%) considered HCRA to be equally important to other standard visit assessments, and 68.3% planned to continue to use HCRA process in the future. A minority reported that HCRA was unimportant (9.8%) and did not plan to use in HCRA subsequently (12.2%). Among patients with evaluable survey data (n=166), most shared (62.0%) or planned to share (25.3%) their results with family members.
Presented by: Neal D. Shore FACS, MD, Urology, Carolina Urologic Research Center and Atlantic Urology Clinics, Myrtle Beach, SC
Written by: Jones Nauseef, MD, PhD, Assistant Professor of Medicine within the Division of Hematology and Medical Oncology, Sandra and Edward Meyer Cancer Center, and Englander Institute for Precision Medicine Weill Cornell Medicine and Assistant Attending physician at NewYork-Presbyterian Hospital. @DrJonesNauseef on Twitter during the 2022 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Thursday, Feb 17 – Saturday, Feb 19, 2022