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2024 Joe Neubauer – PCF Young Investigator Award

Improving Germline Testing Among Veterans with Localized High-Risk or Very High-Risk Prostate Cancer

Daniel Lee, MD
Corporal Michael J. Crescenz VA Medical Center / University of Pennsylvania

Mentors: Neha Vapiwala, MD; Kara Maxwell, MD, PhD

Description:

  • Germline genetic testing, which evaluates for the presence of inherited cancer risk genes, offers multiple possible benefits for patients with high-risk and advanced prostate cancer, and are now part of national guidelines. However, less than 10% of patients with metastatic prostate cancer undergo germline testing, and testing rates are far lower in non-White patients compared with White patients, exacerbating racial disparities in prostate cancer outcomes and limiting the potential benefits of precision medicine and neoadjuvant trials. It is critical to understand and overcome barriers to germline genetic testing.
  • Dr. Daniel Lee’s mentor, Dr. Kara Maxwell, initiated a pilot study of a nursing-led genetic testing program embedded in the medical oncology clinics at the Philadelphia VA, which increased germline testing in patients with metastatic prostate cancer from 30% to 70% overall, and from 20% to 80% for Black Veterans. 
  • In this project, Dr. Lee aims to expand this nursing-led genetic testing program to Urology and Radiation Oncology clinics, to improve outcomes for patients and their families.
  • The current rates of germline testing in patients with high-risk and very high-risk prostate cancer will be determined, with special attention to differences by race and ethnicity.
  • Urologists, radiation oncologists and patients will be surveyed to determine their experiences and perspectives on barriers and facilitators for germline testing. 
  • A nursing-led genetic testing program will be piloted in Urology and Radiation Oncology clinics for patients with localized high-risk and very high-risk prostate cancer, and its impact on improving compliance with germline testing guidelines will be determined. 
  • If successful, this project will identify barriers to germline testing and develop an intervention to improve germline testing in Urology and Radiation Oncology clinical workflows. Ultimately the team plans to test this intervention with a cluster randomized trial throughout the VA Network.

What this means to patients: Germline genetic testing identifies heritable prostate cancer risk genes, and is used to guide personalized management and treatment and indicate cascade testing for family members. Germline testing is recommended for patients with high-risk and advanced prostate cancer, but uptake is low, with significant racial disparities observed. Dr. Lee’s project will identify barriers to genetic testing for clinicians and patients and implement a nursing-led program to integrate germline testing into urology and radiation oncology clinics, which would allow these patients to engage in proper clinical care, cancer screening protocols, and clinical trials.