Investigators from the Prostate Cancer Clinical Trials Consortium (PCCTC) formed the Germline Genetics Working Group (GGWG) in 2017 to provide expert guidance and resources to clinicians “in the face of a rapidly evolving genetics-informed therapeutic landscape.” In 2018 the GGWG published a White Paper outlining a framework to address unique challenges and therapeutic opportunities regarding germline testing for precision therapy in patients with advanced prostate cancer. The current manuscript, “Germline Genetic Testing in Advanced Prostate Cancer – Practices and Barriers”, published in Clinical Genitourinary Cancer, examines the results of a GGWG questionnaire designed to collect information on germline genetic testing patterns.
Key findings – 26 genitourinary oncologists from 19 institutions responded – include the identification of common barriers to obtaining genetic testing. Specifically, a lack of timely access to genetic counselors, lack of insurance coverage or high patient out-of-pocket costs, lack of integrated clinic workflow, time and space constraints, and insufficient resources for provider and patient education were revealed to be the greatest hurdles in expanding the use of germline genetic services in personalized treatment and clinical trial eligibility. The fact that an increasing number of drugs targeting specific genetic profiles are being developed underscores the urgent need to address these barriers.
Notably, all oncologists completing the questionnaire reported that they consider germline genetic testing for at least some of their metastatic prostate cancer patients. This is in line with newly revised National Comprehensive Cancer Network (NCCN) guidelines which recommend germline testing for all patients with high-risk and very high-risk local disease, regional disease, and metastatic disease. Taken together, the GGWG manuscript describes the significant need for physicians, mid-level providers, genetic counselors, practice managers, and other team member to work together to address the aforementioned barriers and bring about an era of Precision Medicine.
The PCCTC’s GGWG meets regularly and is actively involved in developing practical and technical guidelines to advance prostate cancer research and patient care.