Dr. Leapman on Factors Influencing the Decision to Undergo Genomic Testing in Prostate Cancer

Michael S. Leapman, MD, MHS, associate professor of urology, clinical program leader, Prostate & Urologic Cancers Program, Yale Cancer Center, discusses key factors that influence patient experiences with biopsy-based genomic testing during active surveillance for prostate cancer, and how to best address them in clinical practice.

Tissue-based genomic testing is commonly utilized in patients with prostate cancer who are considering active surveillance, and its improvement in disease stratification for this population has been well established. However, the role of patient experiences with biopsy-based testing and its influence on decision-making for active surveillance is underexplored.

To address this, a qualitative descriptive study was performed in patients with low- or favorable to intermediate-risk prostate cancer managed with active surveillance. The patient population included those who received genomic testing as part of routine clinical care, and traditionally underrepresented groups such as Black and Latino men were purposefully over-sampled.

Results showed that a patient's decision to undergo genomic testing was primarily driven by a physician's recommendation, Leapman begins. In some cases, this decision is entirely influenced by the physician, and the option is only explained after testing occurred, he says. In other scenarios, genomic testing is introduced prior to its administration and the choice to administer it is a joint decision between patients and physicians, he details. Some patients are not sufficiently informed about this test at any point in the decision-making process, Leapman notes.

Although patients generally understood the purpose of genomic testing in identifying risk status, many did not understand the difference between genomic testing and genetic testing, Leapman continues. Genomic tests measure mRNA expression, but many patients believe that the test measures heritable characteristics or genetic predispositions, he explains. In cases where the physician provided an explanation, some felt that this communication was still inaccessible and insufficient.

However, such confusion could be easily remedied by providing patients with a more structured overview and the opportunity to ask questions, Leapman emphasizes. Overall, patients desire to be involved and well-informed regarding testing and the decision-making process during active surveillance, Leapman says. Accordingly, clinicians should aim to consciously address this informational deficit in clinical practice, he concludes.