Utilization of genetic counseling and testing for patients with prostate cancer following integration of a genetic counselor into a genitourinary cancer clinic.

Abstract

343 Background: Individuals with prostate cancer may have a 10-20% chance of harboring genetic markers for inherited risk. It is critical that germline genetic testing (GGT) is integrated into prostate cancer care to improve therapy and promote prevention and early detection for individuals and their families. We hypothesized that embedding a genetic counselor (GC) into a multidisciplinary genitourinary (GU) Cancer Clinic would enhance referrals and subsequent GGT. We created a retrospective and prospective study to evaluate the impact on genetic counseling referrals, genetic risk assessments provided, and GGT frequencies before (2016-2018) and after (2019-2022) GC integration into the GU clinic at The James Cancer Hospital at The Ohio State University. Methods: A chart review of 2,593 individuals with prostate cancer seen in the GU program from 2016 to 2022 was performed. Data was analyzed by the Chi Square test. Results: Only 39 referrals to the cancer genetics program were documented in 2016-2019 with an increase to 367 during 2019-2022, despite the COVID pandemic. During the 2016-2019 period GGT was offered to 28% and completed in 26% of referred individuals, whereas GGT was offered to 77% (P<0.0001) and completed in 64% (P<0.0001) in the subsequent period. Individuals proceeding with genetic counseling and GGT were younger in the initial period and became more broadly based in subsequent years. Black patients represented only 8% of referrals in 2016-2019 but increased to 16% in the subsequent period. Individuals with a family history of prostate cancer (P<0.0001) as well as higher Gleason grade (P<0.0001), stage (P<0.0001), metastatic disease (P<0.0001), and PSA (P=0.0507) were more likely to choose genetic counseling. Conclusions: The integration of a GU focused GC into a multidisciplinary GU Cancer Clinic at an academic program dramatically increased genetic counseling referrals, and a greater proportion of individuals with prostate cancer proceeded with GGT. Future studies will analyze barriers and factors promoting referrals to a GC so that we may continue to offer individuals and their families' evidence-based treatment and prevention options.