Disparities in Germline Testing Among Racial Minorities with Prostate Cancer: Bridging Disparities in Germline Testing Among Men with Prostate Cancer

Prior studies have documented that disparities exist in prostate cancer incidence, treatment, and outcomes among racial and ethnic minority groups. The recommendation for germline testing for a large proportion of men with prostate cancer has further exacerbated disparities in diverse patient populations. As genetic testing recommendations from National Comprehensive Cancer Network and other professional societies and expert panels evolve to include more patients, it is critical that urology, oncology, and genetics providers address existing gaps in care for an increasingly diverse population of prostate cancer patients. Expanding genetic testing uptake among racial and ethnic minorities may result in the detection of mutations that drive aggressive prostate cancer, the selection of systemic therapies, and cascade testing for family members. Each of these indications is thought to improve prostate cancer care and outcomes.

Our review highlights multiple barriers to germline testing for medically underserved and racial and ethnic minority populations. Several challenges, including the shortage of genetic counselors, limitations of existing genetic counseling models, and a lack of knowledge of genetic counseling among patients and clinicians have fairly straightforward solutions, which we describe in detail in our review. Other, more complex challenges, including insurance coverage limitations, medical mistrust, and implicit bias among clinicians require a more robust, multifaceted approach that tackles needs for systemic changes in our health care delivery models. Acknowledging and addressing these challenges will be critical in order to address the growing needs of the increasingly diverse population of men with prostate cancer. It is our hope that the noted challenges and proposed solutions are taken into consideration within healthcare settings and medical practices globally in order to enhance care delivery and outcomes for a diverse population of prostate cancer patients.

Written by: Nicole Weise & Rana R. McKay, MD, University of California San Diego, San Diego, CA

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