Dr Maxwell on Strategies to Optimize Genetic Testing in Metastatic Prostate Cancer

Kara N. Maxwell, MD, PhD, assistant professor of medicine (hematology-oncology), Department of Medicine, Perelman School of Medicine, University of Pennsylvania, discusses how findings from a study evaluating the real-world rates of pathogenic germline variants in patients with metastatic prostate cancer may optimize the use of genetic testing to inform treatment decision-making.

This prospective study analyzed pathogenic germline variants in 3 cohorts of patients with metastatic prostate cancer. Patients had either received genetic testing through a point-of-care model at the Basser Center of Penn Medicine, or through cancer genetics practice at the VA Philadelphia health care or VA Greater Los Angeles health care.

Findings presented at the 2024 AACR Annual Meeting demonstrate consistent rates of pathogenic germline variants associated with prostate cancer across diverse patient populations, irrespective of racial differences. Notable discrepancies were observed in variants of uncertain significance, correlating with the racial diversity of each cohort. Moreover, the incidence of DNA repair pathologic germline variants in this study was lower than what prior research had suggested.

Overall, the study underscores the importance of genetic testing in metastatic prostate cancer, particularly given the lower rates of high-yield genetic findings in this patient population, Maxwell emphasizes. Despite the clinical relevance of genetic testing, rates remain low in men with metastatic prostate, pancreatic, and male breast cancers, indicating a critical need to optimize testing strategies, Maxwell states. In response, efforts are underway to implement streamlined genetic testing approaches, such as point-of-care models seen at institutions like the Basser Center of Penn Medicine or nurse-embedded models within the VA system, she details. These innovative strategies aim to increase testing accessibility and efficiency, ensuring that all patients with metastatic prostate cancer have access to genetic testing that can inform personalized treatment decisions, Maxwell explains.

Moving forward, future trials and initiatives within the Basser Center at Penn Medicine are focused on advancing genetic testing approaches to enhance uptake and utilization among metastatic prostate cancer patients and their healthcare providers, Maxwell reports. By promoting wider adoption of genetic testing in clinical practice, researchers aim to improve patient outcomes and advance precision medicine in the management of metastatic prostate cancer, she concludes.