Abstract A139: Evaluating knowledge and practice patterns of prostate cancer germline testing among providers within a large health system

Document Type

Conference Proceeding

Publication Date

9-18-2025

Publication Title

Cancer Epidemiol Biomarkers Prev

Keywords

Oncology, Public, Environmental & Occupational Health

Abstract

Introduction: Prostate cancer (PCa) is common, with survival disparities, especially among African American men and late-stage diagnoses. Germline genetic testing identifies hereditary PCa, linked to BRCA1/2, ATM, PALB2, CHEK2, and MMR mutations in 5-15% of cases. Despite guidelines, genetic testing is underutilized, with provider-level barriers like limited genetics training. Few routinely perform/refer for testing, with higher use in academic settings. Further research is needed across diverse providers. Methods: This mixed-methods study at Henry Ford Health (HFH), a large tertiary system in Detroit, combines a provider survey with retrospective electronic health record review. A 27-item survey was distributed to oncology, radiation oncology, and urology providers to evaluate demographics, knowledge, practices, and barriers. Descriptive statistics were reported, including means for continuous variables and frequencies for categorical variables. Knowledge scores were tallied based on correct answers. Further correlation with clinical data is planned. Results: 21 providers completed the survey: 57% staff, 24% trainees, and 19% advanced practice providers; 71% in oncology, 14% radiation oncology, and 14% urology. 11 identified as White (52.4%), 6 as Asian (28.6%) and 1 as Black/African American (4.8%). 19% do not order germline testing. 42.9% recommend large panel testing with homologous recombination and mismatch repair genes. Knowledge scores varied from 8 to 20 (mean 14). All identified BRCA2 as actionable, but many selected incorrect genes, Most recognized some, but not all, NCCN guideline-based scenarios for testing. 27.3% correctly identified all cancers relevant for family history. Barriers to referrals included insurance issues (36%), limited counselor access (36%), and time constraints (27%). Some providers ordered genetic tests first, referring to counseling only if abnormal. Providers emphasized discussing inheritance, risks/benefits, and genetic discrimination laws. Opinions on testing’s impact on stage III PCa were split, but most agreed it affects family members. Providers agreed that testing facilitates clinical trial enrollment. Perceived barriers included anxiety, cost, health literacy, fear, mistrust, and lack of benefit. Discussion: These findings highlight disparities in germline testing utilization despite guidelines. Provider knowledge gaps highlight training needs, while limited panel testing may reflect infrastructure or interpretation challenges. Addressing barriers requires standardized protocols, integrating genetic counseling, and improving provider training. Provider demographics did not align with HFH’s diverse patient population, a significant portion of whom are Black. This may affect care, particularly genetic counseling referrals. Previous findings show Black patients with stage IV PCa had lower germline testing rates despite higher referral rates and similar counseling attendance. Addressing both provider and patient barriers is essential for equitable access to genetic testing and cancer care.

Volume

34

Issue

9

First Page

A139

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