(UroToday.com) The 2024 GU ASCO annual meeting featured a prostate cancer session and a presentation by Dr. Robert Montgomery discussing remote delivery of cancer genetic testing in veterans with metastatic prostate cancer. Germline pathogenic alterations are found in approximately 10% of men with metastatic prostate cancer and can inform precision therapy, surveillance, and cancer prevention for family.
National guidelines recommend germline genetic testing be offered to all men with metastatic prostate cancer, yet uptake of testing in the community has been documented to be 6-12% with many barriers to testing. As such, Dr. Montgomery and colleagues conducted a study to determine the uptake of testing using remote consenting and testing for veterans with metastatic prostate cancer who had participated in the Veteran’s Administration Million Veteran Program (MVP). The objective of the study was to know if remote testing could overcome limited point-of-care counseling and ordering to increase uptake of germline testing.
This prospective study enrolled veterans who participated in the MVP study with a diagnosis of metastatic prostate cancer. Veterans were contacted by mail with an option to opt-out of further contact. Those who did not opt-out were mailed information regarding the study and received a follow-up phone call to establish interest in germline testing with a CLIA-level germline test (BROCA). Those expressing interest provided verbal informed consent and were mailed a saliva collection kit for a multigene cancer predisposition gene panel test (from the University of Washington). Results were disclosed by phone and mailed to the patient with genetic counseling support and also sent to the oncology provider by email, phone, or both. Two research coordinators and two part-time genetic counselors provided review of consenting and return of results:
As of September 17, 2023, 1,952 veterans who were alive with an incident diagnosis of metastatic prostate cancer were identified through MVP and did not opt out of further contact. Informational letters were sent to the home addresses of all eligible participants, of which 683 (35%) veterans were reached and completed informed consent. All participants were then sent a saliva kit and 457 (23%) completed testing. As follows is a map of MVP participants by home state:
To date, 411 reports have been received, including 54 positive patients for a germline variant mutation (13.1%). Among the participants, the median age was 75, and 70% were White, 21% were Black, 0.5% Asian, and 8% unknown. Among the 54 germline positive results, 30 patients have alterations that may be actionable for therapy:
Dr. Montgomery concluded his presentation discussing remote delivery of cancer genetic testing in veterans with metastatic prostate cancer with the following take-home points:
- This study evaluated uptake of germline testing using a remote, VA system-wide approach to identify and offer genetic testing for veterans with metastatic prostate cancer with access and cost issues removed
- Completed germline testing was at rates significantly higher than those reported in the community with modest personnel requirements, while also reaching a more diverse population of patients
- Remote genetic testing can improve uptake of testing in large integrated healthcare systems
- Given the cost, time efficiency, and the ability to reach patients remotely, centralized remote germline testing may be an effective augmentation of point of care testing
Presented by: Robert B. Montgomery, MD, VA Puget Sound Health Care System, Seattle, WA
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, CA, Thurs, Jan 25 – Sat, Jan 27, 2024.