Precision Medicine Navigator Increases Genomic Testing for Black Patients With Prostate Cancer

The involvement of a precision medicine navigator (PMN)—acting as a liaison between patients with prostate cancer and the health care system—substantially increases the likelihood that Black patients will receive genomic testing, according to a study presented at the American Society for Radiation Oncology 2023 Annual Meeting.

Genomic testing rates are typically lower for Black patients with prostate cancer. Prior research has shown that genomic testing may be better at predicting the risk of metastases than conventional prostate cancer tests, such as the Gleason score and prostate-specific antigen levels.

“Black patients with prostate cancer in the [United States] have disparately worse clinical outcomes compared [with] other racial groups,” said lead study author Alexander J. Allen, MD, a radiation oncology resident physician at the University of Maryland Medical Center. “Our findings suggest hiring a PMN who specializes in genetic testing can improve the rates of Black patients receiving these tests, which could potentially reduce health disparities and improve outcomes.”

Dr. Allen and colleagues compared how frequently patients with prostate cancer in a large health care system received genetic testing from the 7 months prior to the arrival of a PMN to the 7 months following the arrival. A total of 693 patients were sampled, of whom 311 were treated prior to the arrival and 382 were treated postarrival.

Researchers noted the median age in both groups was 68 years, and the racial distributions were similar (60.0% White; 35.1% and 34.0% Black, respectively; 3.2% and 3.7% Asian/Pacific Islander, respectively; and 1.3% and 2.1% Latino, respectively). No significant differences were reported between the groups in terms of disease severity, type of insurance, or type of treatment facility.

Results showed that Black patients seen by the PMN were 6 times more likely to receive testing than those not seen by the PMN. After the arrival of the PMN, the proportion of Black patients referred for genomic testing increased from 19% to 58%.

Similar increases in genomic testing rates after the arrival of the PMN were seen in lower-income patients (20% to 64%), those on Medicare or Medicaid (20.0% to 68.5%), and those who were treated at community hospitals (6% to 77%).

Dr. Allen and colleagues were surprised the testing rates grew so substantially, and they noted that genomic testing results altered treatment plans for many patients. “The most common way treatments were altered based on genomic testing results was in whether or not patients with intermediate-risk disease were given hormone-blocking therapy,” he said.

The next step is to design a study that investigates whether the increased rates of genomic testing lead to better patient outcomes. However, Dr. Allen and colleagues believe that making genomic testing more accessible is key to mitigating racial disparities in prostate cancer.