Prostate cancer-related genetic counseling in a safety-net healthcare setting

Germline genetic testing and genetic counseling have become integral aspects of prostate cancer management. In 2018, the National Comprehensive Cancer Network (NCCN) broadened testing recommendations to identify more at-risk individuals based on tumor characteristics and family cancer history. We assessed genetic counseling referrals and outcomes in relation to this expansion in a large safety-net population.

We analyzed cases of prostate adenocarcinoma diagnosed in 2016 to 2023 at JPS Health Network (JPS), a safety-net provider in Texas. Demographic and clinical data including genetic counseling referrals and testing results were obtained from cancer registries and electronic health records. Statistical analysis was performed using logistic regression model.

Among 543 patients, 46% were Black, 27% were Hispanic, and 40% had metastatic disease. Overall, 132 patients (24%) were referred for genetic counseling, of whom 102 (77%) completed the visits. Rates of referrals increased from 4% in 2017 to 9% in 2019 to 28% in 2023. A multivariate logistic regression determined that patients with stage 3 or 4 cancers were more likely than stage 1 to be referred (P = 0.02 and P < 0.01 respectively). Genetic testing was completed for 78 patients (76%) with 8 (10%) having 9 positive results in BRCA1 (n = 1), BRCA2 (n = 1), CHEK2 (n = 3), MSH2 (n = 2), PALB2 (n = 1), and PMS2 (n = 1).

Following guideline changes, genetic testing referrals for patients with prostate cancer increased approximately 7-fold in a safety-net setting. Over three-fourths of referred patients completed testing and 10% had positive results, demonstrating the feasibility and importance of genetic testing in underserved populations.