Embedding genetic testing in the metastatic prostate cancer pathway: understanding patient and physician perspectives

Abstract

Aim: To understand how genetic (homologous recombination repair [HRR], including BReast CAncer [BRCA]) testing is being embedded in clinical practice and identify testing challenges given global approvals of poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPis) for metastatic prostate cancer (mPCa). Methods: Data from two Adelphi Real World Prostate Cancer Disease Specific Programmes™ (DSPs; 2020 and 11/2022–7/2023) were analyzed and compared using appropriate bivariate tests. Results: Genetic testing was performed among 45% (855/1899) of patients with mPCa (castration-sensitive [mCSPC]: 36%; castration-resistant [mCRPC]: 49%; HRR genes: 43% [34%; 47%]; BRCA: 42% [34%; 46%]). Testing increased from 2020: HRR genes by 17% (p < 0.01); BRCA by 18% (p < 0.01). HRR gene and BRCA mutations were reported in 16% (mCSPC: 13%; mCRPC: 18%) and 15% (13%; 16%) of patients, respectively. In the 2022–2023 DSP, 56% of physicians indicated they were more likely to conduct HRR gene testing following PARPi availability. Patient refusal, costs, reimbursement issues, low sample availability, and result delays were testing challenges. Among 40% of patients who spoke with physicians about testing, 83% were tested, and 49% reported knowing results helped. Conclusions: Understanding physicians’ and patients’ experiences with, and challenges surrounding, genetic testing for PCa may facilitate better clinical-management interactions.