The efficacy of point of care (POC) hereditary cancer genetic testing among patients with prostate cancer.

495 Background: Hereditary cancer genetic testing is recommended for all prostate cancer patients with high-risk or metastatic disease as well as those with specific family histories and ethnic backgrounds. Approximately 15% of such patients have pathogenic germline mutations, which can directly inform therapeutic options and have important implications for patients and their family members. Despite this, testing remains underused and is only performed in 10-60% of eligible patients. Studies have shown that POC testing can markedly increase testing uptake. In this project we assessed the efficacy of a POC testing model among prostate cancer patients. Methods: The traditional model for hereditary cancer genetic testing includes pre-test counseling with a genetic counselor (GC). Our POC model utilized a standardized educational video and handout in place of traditional pre-test counseling with testing consent and sample collection subsequently obtained during medical oncology visits. In both testing models, patients had a post-test visit with a GC to review results. To assess the efficacy of the POC model we retrospectively reviewed all patients seen at our institution between 1/2022 and 6/2024 with either metastatic or high-risk prostate cancer who did not explicitly decline germline testing. The proportion of patients who underwent successful germline testing in the pre-POC period (1/2022-12/2022) was compared to the proportion in the POC period (1/2023-6/2024) with a chi-square test. We defined successful testing as testing performed within 6 months of a referral being placed. Additionally, we assessed changes in the rate of germline testing in historically disadvantaged patients including non-white patients, Spanish speaking patients, and patients from the outer boroughs of NYC. Results: 445 patients were seen during the study period with metastatic or high-risk prostate cancer: 137 in the pre-POC period with 21 declining testing and 308 in the POC period with 58 declining testing. Over the two study periods the number of patients undergoing successful germline testing increased from 9 patients (7.8%) to 134 patients (54%). (p=<0.001). In the pre-POC period 0/3 Spanish speaking patients, 0/12 non-white patients, and 4/63 (6.3%) patients from NYC outer boroughs underwent germline testing. In the POC period 7/11 (64%) Spanish speaking patients, 23/59 (59%) non-white patients and 64/132 (48%) patients from NYC outer boroughs underwent germline testing. In the overall tested population 25/187 (13%) patients had a pathogenic germline mutation discovered by testing. Conclusions: Hereditary cancer genetic testing is an important component of prostate cancer management. This study demonstrated that a POC testing model significantly improves the rate of testing among prostate cancer patients. The program was particularly effective for those from historically disadvantaged subgroups.