Education, Collaboration Key to Increasing Genetic Screening in Prostate Cancer

Thomas J. Polascik, MD

With the advent of targeted therapy, understanding the genetic components of a patient's disease has become critical in oncology. As the role of genetic testing in prostate cancer has grown, the field is also overcoming hurdles with making it more widespread, said Thomas J. Polascik, MD.

Challenges regarding genetic testing have included a lack of awareness, inconsistencies in testing guidelines, and scarce resources, explained Polascik. However, he said, educational efforts and collaboration with other experts may begin to chip away at these challenges.

"As medicine becomes more complicated, you have to bring in teams [of people] with different expertise," said Polascik. "Clinicians are busy. They have limited time to talk about issues with patients. Perhaps sending patients to genetic counselors or other specialists is the best solution. That way, patients get to interact with many professionals of different expertise."

In an interview with OncLive, Polascik, a urologic oncologist at Duke University, discussed the growing relevance of genetic testing for men with prostate cancer and those at a high risk of developing the disease.

OncLive: What are the main considerations for germline testing in prostate cancer?

Polascik: We look at men with high-risk disease. They [typically] have high Gleeson scores, and metastatic or locally advanced disease. [We also look at men] who have a known genetic aberration that runs in the family.

What unmet needs should be addressed regarding genetic testing?

There are several. We do not know the implications of these genetic abnormalities—some may lead to potential treatments, while we are currently gathering data on other [abnormalities].

From an institutional point of view, it will be interesting to see how people put this together to make it work at their institution. There are a lot of moving parts, and it is largely a collaborative effort. We have worked tightly with primary care [physicians to try] to devise a system that works for everyone. A physician's time is short, and there is a lot to get accomplished at these clinic visits. It is not just about prostate cancer.

What is the best way to educate others on the importance of molecular testing?

Educational activities at the home institution are the best. We did Lunch and Learns when we went out to speak about prostate cancer screening. People were able to take the time to listen to presentations and interact [with one another].

For clinicians who are serious about offering [genetic testing to their patients], educating the entire team [is necessary]. Everyone [including] from doctors to nurses have to speak the same message.

I also learned that there are a lot of guidelines out there. As a urologist, I tend to quote the American Urological Association. There are also [guidelines by] the European Association of Urology, the National Comprehensive Cancer Network, and the American College of Surgeons. In the end, this becomes very confusing. [Physicians] want to do the right thing, but they are unsure what the [right thing is].

What efforts are being made to harmonize these guidelines to make them easier to understand?

That is what we are doing at Duke [University]. We formed a panel with a number of stakeholders who had input to come up with what we considered best practice [guidelines].

There is a difference between level 1 data and other ideas in the literature. We looked at both. There are some problems with level 1 data. For example, [data from a] European study is based predominantly on a Caucasian cohort, but we have other racial groups represented in our part of the country. The Caucasian experience is not relevant to them.

We also thought performing a baseline genetic test for men in their 40s was important. It could predict the likelihood of developing cancer, and, for some people, lethal cancer. Men want to know about this, particularly if they can influence the natural history of events.

How do you see the role of genetic testing changing in the coming years?

Like a lot of aspects [of medicine], genetic testing may be largely patient-driven. A lot of pharmaceutical companies directly market to patients. Patients are going to hear about [services like] 23andMe and ask physicians what their results mean. A lot of this will be driven by the consumers.