Department of Urology, New York University and the Manhattan Veterans Affairs, NY, USA; Department of Population Health, New York University, NY, USA.
Department of Urology, New York University and the Manhattan Veterans Affairs, NY, USA; Department of Population Health, New York University, NY, USA.
Cancer Treat Res Commun. 2020;25:100212. doi: 10.1016/j.ctarc.2020.100212. Epub 2020 Sep 28.
Germline testing is recommended for all men with metastatic prostate cancer (PCa), and for some with localized PCa meeting specific histologic or family history criteria. Germline genetic evaluation has important implications for PCa prognosis and management, as well as implications for family members and cancer screening. Despite the importance of germline evaluation, its utilization in urologic practice is unknown.
We conducted a 32-item survey of U.S. urologists to examine knowledge of germline testing guidelines and practice patterns. It was shared through email to 6 American Urological Association sections, the Veterans Affairs Urology Mailgroup, and social media.
Among 132 total respondents from diverse practice settings across the U.S., 12% perform germline testing, 44% refer to a genetic counselor, 11% do both, and 33% do not test/refer. Only 4% had formal education in genetics. While 98% ask about PCa family history, only 76% and 52% ask about breast and ovarian cancer. When presented with hypothetical case scenarios where germline testing is indicated, many respondents indicated they would not offer genetic counseling or testing. Younger age (p = 0,03), academic practice (p = 0.04), and specializing in PCa/oncology (p = 0.007) were significantly associated with performing or referring for germline testing. Specializing in PCa/oncology was significantly associated with recommending germline testing for all case scenarios involving metastatic PCa (p = 0.0009) CONCLUSION: Our results suggest significant gaps in knowledge of germline testing and alignment of practice with national guidelines among urologists. Germline testing education and facilitation of genetic evaluation in urologic practice is warranted.
建议对所有转移性前列腺癌（PCa）男性以及符合特定组织学或家族史标准的局限性 PCa 男性进行种系检测。种系遗传评估对 PCa 的预后和管理具有重要意义，也对家庭成员和癌症筛查具有重要意义。尽管种系评估很重要，但它在泌尿科实践中的应用情况尚不清楚。
我们对美国泌尿科医生进行了一项 32 项调查，以检查他们对种系检测指南和实践模式的了解。该调查通过电子邮件分发给美国泌尿外科学会的 6 个分会、退伍军人事务部泌尿科邮件组和社交媒体。
在美国不同实践环境的 132 名总应答者中，12%的人进行种系检测，44%的人向遗传咨询师咨询，11%的人同时进行种系检测和咨询，33%的人既不检测也不咨询。只有 4%的人接受过遗传学方面的正规教育。尽管 98%的人会询问 PCa 的家族史，但只有 76%和 52%的人会询问乳腺癌和卵巢癌的家族史。当呈现出需要进行种系检测的假设病例场景时，许多应答者表示他们不会提供遗传咨询或检测。年龄较轻（p=0.03）、学术实践（p=0.04）和专门从事 PCa/肿瘤学（p=0.007）与进行或推荐种系检测显著相关。专门从事 PCa/肿瘤学与推荐对所有涉及转移性 PCa 的病例场景进行种系检测显著相关（p=0.0009）。
我们的结果表明，泌尿科医生对种系检测的知识存在明显差距，其实践与国家指南的一致性也存在差距。泌尿科医生需要进行种系检测教育，并促进遗传评估在泌尿科实践中的应用。
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