Genetic Counseling Processes and Outcomes Among Males With Prostate Cancer (ProGen)

Study Overview
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Brief Summary
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This randomized controlled trial aims to evaluate the impact of pre-test video education and post-test genetic counseling as compared to in-person pre-test genetic counseling in males with advanced prostate cancer.

Detailed Description
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Participants will be randomized to either pre-test video education and post-test genetic counseling or in-person pre-test genetic counseling. Outcomes evaluated are: prevalence of germline mutations, uptake of genetic testing, satisfaction with testing, knowledge of multi-gene panels, distress, result disclosure to relatives, and the impact on personal or family medical care. Through this study, the investigators will learn about the inherited causes of prostate cancer, and how and when genetic testing should be offered to this population.

Official Title
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Genetic Counseling Processes and Outcomes Among Males With Prostate Cancer (ProGen)

Conditions
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Prostate Cancer

Intervention / Treatment
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* Other: Traditional pre-test genetic counseling
* Other: Pre-test video education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Metastatic prostate cancer (hormone-sensitive, de novo, or castration resistant) Localized prostate cancer with Gleason score ≥8 Rising PSA after prostatectomy or radiation with PSA doubling time ≤ 6 months Persistent PSA after prostatectomy for PSA ≥ 0.2 ng/mL observed in testing at least 1 week apart Prostate cancer diagnosed at age ≤ 55 years Prostate cancer and a personal history of prior malignancy that does not include non-melanoma skin cancer or superficial bladder cancer. Prostate cancer diagnosis (any grade/stage) or prostate biopsy with high grade PIN or small acinar proliferation and a family history potentially indicating a germline mutation (e.g. breast cancer diagnosed at age ≤ 50, ovarian, pancreatic, uterine, colorectal, prostate cancer or sarcoma, in one or more first or second-degree relatives) Exclusion Criteria: Previous cancer genetic testing or counseling, or prior germline multigene panel testing. Previous tumor sequencing is acceptable if no genetic counseling took place. Localized prostate cancer previously treated and in remission for > 2 years unless family history potentially indicates a germline mutation. Active hematologic malignancy (e.g. CLL)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional pre-test genetic counseling<br>In-person consultation with licensed genetic counselor at the Center for Cancer Genetics and Prevention before genetic testing Participant is given a pamphlet introducing prostate cancer genes, genetic testing Participant is sent electronic family history tool Participant is given the Genetic Testing Information for Decision Making packet. After the genetic counseling session, patient is asked if they would like to proceed with genetic testing. | Other: Traditional pre-test genetic counseling<br>* Participant meets with a genetic counselor at the Center for Cancer Genetics and Prevention and traditional pre-test cancer genetic counseling is provided<br>|
| Experimental: Pre-test video education<br>Participant is given a pamphlet that describes the basics of prostate cancer genes, genetic testing Participant is sent electronic family history tool Participant is approached in clinic by research staff at a pre-planned time The patient is given the Genetic Testing Information for Decision Making packet The pre-test video education is a short video. Information will be provided about the basics of genetics and mutations, the potential benefits, risks, and limitations of genetic testing, and the possible results the participant may receive | Other: Pre-test video education<br>* The video is designed to mirror the educational components of a traditional genetic counseling visit<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of germline mutations in males with prostate cancer | The proportion of participants who test positive for pathogenic or likely pathogenic variants | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Genetic testing uptake | The proportion of participants who consent to genetic testing in the pre-test video education arm | 2 years | 
| Secondary or other primary (non-prostate) malignancies | Assessed by chart review. Participants with positive genetic test results will fill out the Positive Test Results Survey to report any additional cancer diagnoses. | 2 years | 
| Genetic testing satisfaction score | A validated survey of participants' satisfaction with the genetic counseling and testing process will be used. For the survey at the time of post-counseling, the survey for the video education arm consists of 8 questions and the genetic counseling arm contains an additional question about perceived length of the visit. The parameters for measurement are disagree strongly, disagree, neither agree or disagree, agree, and agree strongly. At the time of 1 month post-result disclosure, an additional set of 5 questions will be added. Four of these five questions will be evaluated using the previously described parameters. The remaining question will be answered by the response options: yes, no, or I did not get the packet. Survey responses will be re-coded on a numerical scale consistent with the standard Likert scale. | at time of post-counseling/video pre-result disclosure and at 1 month post-result disclosure | 
| Multidimensional Impact of Cancer Risk Assessment score and subscales | MICRA is a widely used validated 25-item measure that assesses psychosocial consequences associated with genetic testing for cancer. Section 1 contains 3 sub-scales: the Positive sub-scale (4 items), the Distress sub-scale (6 items), and the Uncertainty sub-scale (9 items) and two other items that do not fit into either sub-scale. Section 2 contains two items for participants who have children. Section 3 contains 2 items for participants who have/have had cancer. Responses are indicated on a 4 point scale for experiences in the past week. A higher score in the sub-scales or total scale indicated greater distress. The positive sub-scale is reverse scored to reflect this. | 1 and 4 months post-result disclosure | 
| Knowledge of multigene panel testing score | A 24 item investigator-developed knowledge scale applicable to this population was developed through an expert panel and in-depth patient cognitive interviews to determine if participants are able to recall key core components about multi-gene panel testing. Each item provides three choice answers: agree, disagree, or I don't know. Knowledge will be scored on the number of correct responses where higher correct responses represents more knowledge of multigene panel testing. | 4 months post-result disclosure | 
| Family communication for those who tested positive for a genetic mutation | For those participants who have tested positive for a mutation, 5 items will be asked pertaining to disclosure of genetic testing results to relatives that are derived from previous literature. | 1 and 4 months post-result disclosure | 
| Intent to disclose genetic test results | Three items will assess participants' intentions to disclose genetic testing results. | pre-result disclosure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prostate Cancer, Genetics