Gratzke Christian, Aggarwal Himani, Kim Jeri, Chaignaud Holly, Oskar Sabine
Department of Urology, University Hospital Freiburg, Freiburg, Germany.
Merck & Co. Inc, Rahway, NJ, USA.
Eur Urol Open Sci. 2024 Oct 10;71:148-155. doi: 10.1016/j.euros.2024.07.113. eCollection 2025 Jan.
Treatment landscape in advanced prostate cancer (PC) is evolving. There is limited understanding of the factors influencing decision-making for genetic/genomic testing and the barriers to recommending testing and treatment in international real-world clinical practice following the approval of poly-adenosine diphosphate-ribose polymerase inhibitors (PARPi) for metastatic castration-resistant PC (mCRPC). This work aims to assess genetic/genomic testing patterns and methods, including for homologous recombination repair mutation (HRRm), and treatment decisions among physicians caring for patients with PC across the USA, Europe, and Asia.
A cross-sectional online survey of physicians treating patients with advanced PC was administered in the USA, France, Germany, Italy, Spain, UK, Japan, and China. Physicians were recruited (from August to December 2022) via clinical panels and provided informed consent. Survey questions covered factors influencing HRRm testing and treatment decision-making.
Physicians reported that 50% of patients with mCRPC are recommended for HRRm testing, and among those recommended for testing, 60% are recommended for mutation testing and 65% go on to receive HRRm testing. Overall proportions of patients recommended for testing increased following PARPi approval (from 20% to 50%) and following updated practice guidelines (from 25% to 50%). Perceived barriers to the use of genetic/genomic testing included patient refusal, lack of insurance/reimbursement, and lack of availability of adequate tissue for testing.
Overall, testing rates increased following PARPi approval and updated clinical practice guidelines; yet, there was a wide variation in the proportions of patients with mCRPC recommended for testing, and perceived barriers to testing remain, suggesting unmet needs for patients and physicians.
We surveyed physicians globally about their experience in treating patients with advanced prostate cancer and genetic testing. Physicians reported that half of patients are recommended for genetic testing, which varied across countries. We conclude that barriers to testing remain for patients and physicians.
晚期前列腺癌（PC）的治疗格局正在演变。对于多聚腺苷二磷酸核糖聚合酶抑制剂（PARPi）获批用于转移性去势抵抗性前列腺癌（mCRPC）后，国际真实世界临床实践中影响基因/基因组检测决策的因素以及推荐检测和治疗的障碍，人们了解有限。这项研究旨在评估美国、欧洲和亚洲负责诊治PC患者的医生的基因/基因组检测模式和方法，包括同源重组修复突变（HRRm）检测，以及治疗决策。
在美国、法国、德国、意大利、西班牙、英国、日本和中国对治疗晚期PC患者的医生开展了一项横断面在线调查。通过临床小组招募医生（2022年8月至12月）并获取其知情同意。调查问题涵盖影响HRRm检测和治疗决策的因素。
医生报告称，50%的mCRPC患者被推荐进行HRRm检测，在被推荐检测的患者中，60%被推荐进行突变检测，65%最终接受了HRRm检测。PARPi获批后（从20%增至50%）以及更新的实践指南发布后（从25%增至50%），被推荐检测的患者总体比例有所增加。基因/基因组检测的已知障碍包括患者拒绝、缺乏保险/报销以及缺乏用于检测的足够组织。
总体而言，PARPi获批和更新临床实践指南后检测率有所提高；然而，mCRPC患者被推荐检测的比例差异很大，且检测的已知障碍仍然存在，这表明患者和医生的需求未得到满足。
我们对全球医生治疗晚期前列腺癌和基因检测的经验进行了调查。医生报告称，一半的患者被推荐进行基因检测，各国情况有所不同。我们得出结论，患者和医生在检测方面仍然存在障碍。
