Clinician-Reported Management Recommendations in Response to Universal Germline Genetic Testing in Patients With...

Area of Science:

• Oncology
• Genetics
• Clinical Decision-Making

Background:

• Germline pathogenic variants in prostate cancer inform treatment, secondary malignancy screening, and cascade testing.
• Limited real-world data exist on clinician recommendations post-germline genetic testing for prostate cancer patients.

Purpose of the Study:

• To evaluate clinician recommendations following germline genetic testing in prostate cancer patients.
• To assess the impact of germline variant status on clinical decision-making.

Main Methods:

• Data collected from unselected prostate cancer patients undergoing germline testing (PROCLAIM trial).
• Statistical analysis included 2-tailed Fisher's exact test and logistic regression.
• Controlled for diagnosis timing (newly vs previously diagnosed).

Main Results:

• 10% of 982 patients had positive germline results, 49% uncertain, and 41% negative.
• Positive results significantly increased recommendations for treatment (18% vs 1.4%), follow-up (64% vs 11%), and cascade testing (71% vs 5.4%).
• Both positive and uncertain results were associated with treatment and follow-up changes (P < .001).

Conclusions:

• Germline genetic testing results, especially positive ones, guide clinical recommendations in prostate cancer.
• Significant clinical management changes occurred even with uncertain results, indicating a need for better clinician genetic education.