Alexandra Sokolova

Alexandra Sokolova, MD, a hematology/oncology fellow of the University of Washington, discusses the rationale for ​systematic germline testing in patients with metastatic prostate cancer.

In 2017, the National Comprehensive Cancer Network (NCCN) guidelines recommended germline testing for all men with metastatic prostate cancer, says Sokolova. In 2019, the guidelines were updated to include all men with high-risk, localized prostate cancer or those with a family history ​of prostate cancer. 

Implementation of a better genetic testing model is an area of unmet need in prostate cancer as there is no streamlined infrastructure to deliver effective services to these men, explains Sokolova. To that end, a prospective, pilot study aimed to test the feasibility of systematic genetic testing in all men with metastatic disease receiving care at the VA Puget Sound Health Care System.

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Alexandra Sokolova, MD, discusses the rationale for ​systematic germline testing in patients with metastatic prostate cancer.

  Dr. Sokolova on the Rationale for Systematic Germline Testing in Prostate Cancer

Alexandra Sokolova, MD, a hematology/oncology fellow of the University of Washington, discusses the challenges of germline testing in patients with metastatic prostate cancer. 

The lack of infrastructure to facilitate efficient germline testing is an unmet need, says Sokolova. Traditionally, ​when patients aresent to a genetic counselor, they must undergo pre-test counseling, germline testing, and post-test counseling.

This method can be time consuming, and there is a lack of available resources to provide this service to eligible patients. Providingan alternative model that could help them streamline the resources could lead to better care for their patients, Sokolova adds. 

In an IRB-approved prospective trial, genetic counseling was conducted through video meetings. This method appeared effective, especially when the patients were comfortable with the ​genetic provider, Sokolova concludes.

Alexandra Sokolova, MD, discusses the challenges of germline testing in patients with metastatic prostate cancer. 

Dr. Sokolova on Challenges of Germline Testing in Metastatic Prostate Cancer

Alexandra Sokolova, MD, a hematology/oncology fellow of the University of Washington, discusses the systematic implementation of a germline testing protocol for patients with metastatic prostate cancer.

In an IRB-approved, prospective trial, investigators evaluated the feasibility of implementing a systematic workflow to identify patients with metastatic prostate cancer receiving care at the Puget Sound VA Prostate Cancer Clinic. To this end, a research coordinator prescreened each clinic schedule to identify patients with metastatic prostate cancer who qualified for germline testing and subsequently notified oncologists caring for those patients.

Oncologists would then discuss germline testing with their patients during follow-up appointments, says Sokolova. In these discussions, oncologists would explain what the testing is, the potential benefits of these tests for both patient and their family members, and weigh the pros and cons of undergoing such testing. If patients were interested, after signing a consent form, they would provide a saliva test the same day of their appointment. This made the process simple and convenient for patients, as they would not need to make another appointment or visit another clinic to get the testing done, Sokolova adds.

Furthermore, genetic counseling was provided by the Color Genomics 30-gene cancer gene panel utilized for the testing. As such, patients had the opportunity to participate in post-test counseling with a genetic counselor. If interested, they would be referred to a local counselor, Sokolova concludes.

Alexandra Sokolova, MD, discusses the systematic implementation of a germline testing protocol for patients with metastatic prostate cancer.

Dr. Sokolova on Implementing a Germline Testing Protocol for Metastatic Prostate Cancer

Alexandra Sokolova, MD, a hematology/oncology fellow of the University of Washington, discusses the rationale for systematic implementation of germline testing for patients with metastatic prostate cancer.

In a prospective, IRB-approved trial, investigators sought to evaluate whether systematic identification of men with metastatic prostate cancer correlated with a high uptake of germline testing, says Sokolova. In the study, a research coordinator prescreened each clinic schedule to flag patients with metastatic prostate cancer. Then, these coordinators would notify the oncologist. Knowing which patients qualified for germline testing reminded oncologists to discuss germline testing with their patients, says Sokolova.

When speaking with patients with metastatic prostate cancer, there's a lot of information that must be covered in these important discussions, such as symptoms, quality of life, and treatment plans, among others, says Sokolova. As such, it’s easy for germline testing to escape an oncologist’s attention, especially with regard to patients whom they have been seeing for quite some time.

As such, alerting oncologists when a patient qualifies for this testing, and doing so in a systematic manner, could help to create an infrastructure that could help oncologists remember to discuss germling testing with their patients, concludes Sokolova.

Alexandra Sokolova, MD, discusses the rationale for systematic implementation of germline testing for patients with metastatic prostate cancer.

Author | Alexandra Sokolova

Articles

Dr. Sokolova on the Rationale for Systematic Germline Testing in Prostate Cancer

Dr. Sokolova on Challenges of Germline Testing in Metastatic Prostate Cancer

Dr. Sokolova on Implementing a Germline Testing Protocol for Metastatic Prostate Cancer

Dr. Sokolova on the Rationale for Systematic Implementation of Germline Testing for Metastatic Prostate Cancer