Survey Reveals Global Practices and Barriers in Genetic Testing for mCRPC

A recent survey examined how physicians in the U.S., Europe, and Asia practice genetic and genomic testing for patients with metastatic castration-resistant prostate cancer (mCRPC). The survey gathered responses from 1,195 physicians, with 407 completing it. Among those, 100 were from the U.S., 132 from five European countries (France, Germany, Italy, Spain, and the UK), 100 from Japan, and 75 from China. Respondents included urologists (43%), oncologists (40%), and pathologists (17%).

The survey found that 50% of patients with mCRPC were recommended for homologous recombination repair (HRR) mutation testing. Of those recommended, 60% were for BRCA1/2 mutation testing, and 65% actually received HRR mutation testing. Recommendations varied by setting, with a median of 50% of patients recommended in academic centers and 46% in community centers.

Physicians were most likely to recommend testing at the diagnosis of mCRPC (52%), at the diagnosis of metastatic hormone-sensitive prostate cancer (mHSPC) (45%), or after the first line of treatment for mCRPC (44%). After the approval of poly-adenosine diphosphate-ribose polymerase (PARP) inhibitors, the percentage recommended for genetic testing rose significantly. Before the approvals in May 2020 (U.S.) and later in other regions, only about 20% of patients were recommended testing. After approval, this increased to 50%.

In Germany, recommendations jumped from 10% to 70%, while in France, they rose from 15% to 30%. In academic centers, recommendations increased from 26% to 55%, and in community centers, from 10% to 50%.

The authors noted updates to clinical guidelines also affected testing recommendations. Before the updates, 25% of patients were recommended for HRR mutation testing; this increased to 50% afterward. The U.S. saw the most significant rise, going from 15% to 68%, while in France, the increase was more modest, from 20% to 25%.

Limited insurance coverage and patient refusals remained the main barriers to testing. Challenges included patient refusals (41%), longer turnaround times for results (40%), and limited access to genetic counseling (40%). The authors suggested that increased use of circulating tumor DNA (ctDNA) testing could help mitigate inadequate tissue availability.

Some limitations of the survey include potential selection bias and recall bias, which could affect the accuracy of results. The authors recommend further study. They noted that new PARP inhibitor approvals for first-line patients with mCRPC may influence testing and treatment patterns moving forward.

For more detailed findings, refer to the study by Gratzke et al., published in Eur Urol Open Sci (DOI: 10.1016/j.euros.2024.07.113).