Tissue-based gene expression (genomic) tests provide estimates of prostate cancer aggressiveness and are increasingly used for patients considering or engaged in active surveillance. However, little is known about patient experiences with genomic testing and its role in their decision-making.
We performed a qualitative study consisting of in-depth, semi-structured interviews of patients with low- or favourable-intermediate-risk prostate cancer managed with active surveillance. We purposively sampled to include patients who received biopsy-based genomic testing as part of clinical care. The interview guide focused on experiences with genomic testing during patients' decision-making for prostate cancer management and understanding of genomic test results. We continued interviews until thematic saturation was reached, iteratively created a code key and used conventional content analysis to analyse data.
Participants' (n = 20) mean age was 68 years (range 51-79). At initial biopsy, 17 (85%) had a Gleason grade group 1, and 3 (15%) had a grade group 2 prostate cancer. The decision to undergo genomic testing was driven by both participants and physicians' recommendations; however, some participants were unaware that testing had occurred. Overall, participants understood the role of genomic testing in estimating their prostate cancer risk, and the test results increased their confidence in the decision for active surveillance. Participants had some misconceptions about the difference between tissue-based gene expression tests and germline genetic tests and commonly believed that tissue-based tests measured hereditary cancer risk. While some participants expressed satisfaction with their physicians' explanations, others felt that communication was limited and lacked sufficient detail.
Patients interact with and are influenced by the results of biopsy-based genomic testing during active surveillance for prostate cancer, despite gaps in understanding about test results. Our findings indicate areas for improvement in patient counselling in order to increase patient knowledge and comfort with genomic testing.
BJUI compass. 2023 Aug 15*** epublish ***
Michael S Leapman, Ryan Sutherland, Cary P Gross, Xiaomei Ma, Tyler M Seibert, Matthew R Cooperberg, William J Catalona, Stacy Loeb, Dena Schulman-Green
Department of Urology Yale School of Medicine New Haven Connecticut USA., Yale School of Medicine New Haven Connecticut USA., Yale Cancer Outcomes Public Policy, and Effectiveness Research Center New Haven Connecticut USA., Department of Radiation Medicine and Applied Sciences University of California San Diego La Jolla California USA., Department of Urology University of California San Francisco San Francisco California USA., Department of Urology Northwestern University Feinberg School of Medicine Chicago Illinois USA., Departments of Urology and Population Health New York University Langone Health New York New York USA., New York University Rory Meyers College of Nursing New York New York USA.