Leapman On Improving Genomic Testing Communication For Patients With Prostate Cancer

Patients with prostate cancer who undergo tissue-based genomic testing as part of active surveillance protocol may be unaware that testing has occurred or have significant misperceptions about the results and their clinical meaning, according to Michael S. Leapman, MD, MHS, associate professor of urology and clinical program leader of the Prostate and Urologic Cancers Program at Yale Cancer Center.

Leapman recently presented on the topic during the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO GU). As Leapman points out, tissue-based gene expression tests are used to assess disease aggressiveness and inform decisions during active surveillance, but little is known about how patients perceive these tests and their results.

“It’s clear from this experience, that patients really want to know more about their testing— that they understood some components of it, but had a lot of questions,” Leapman told Oncology Nursing News®.

“I think the message is to really slow down and make sure patients have the opportunity to ask the questions they want, and to give a structured overview of the important information,” he said.

Investigators sampled a population that was representative of their patient population, but with purposeful efforts to ensure that racial minorities that are historically underrepresented in prostate cancer studies were included. The sample also included patients who were seen by community affiliated providers, academic providers, and patients treated at the Veterans affairs hospital.

The total sample was 20 patients with a mean age was 68 years (range, 51-79). Fourteen were White (70%), 5 were Black (25%), and 2 were Hispanic/Latino (10%). At the time of diagnosis, 17 (85%) were classified as Gleason grade group 1 and 3 (15%) were grade group 2.

Some of the patient response quotes derived from the study included the following:

“[My urologist] wanted to learn more to see if there’s decision for anything there that he was missing. So, we had to go through a [genomic] test.”

“The genomic test... More than any other test, that’s the one that I trusted. and that’s how I came to the conclusion…for active surveillance.”

“As far as the genomic testing, I never really got much information about that at all. Only, ‘Hey, your score is, low probability of like 3 out of 10 or something…. it’s pretty rambly information.”

“But the DNA shouldn’t change, you would think. My assumption is the DNA is the DNA.”

“I would prefer [my doctor] look me in the eye and sa,...here’s the genomic testing, and here’s the data. And do you want to hear more of the data? Or are you good with this? You [have] a 2% chance of dying in 10 years, is that enough or do you want to see more?”

These findings inform the need for more effective strategies to communicate genomic testing results to patients, Leapman concluded.

Reference

Leapman MS, Sutherland R, Gross CP, et al. Patient experiences with tissue-based genomic testing during active surveillance for prostate cancer. J Clin Oncol. 41;2023(suppl 6):333. doi:10.1200/JCO.2023.41.6_suppl.333