A quality improvement initiative to improve genomic testing rates in patients with prostate cancer.

Abstract

e23316 Background: The therapeutic landscape of metastatic prostate cancer has rapidly evolved with the integration of precision oncology. Emerging data from the AMPLITUDE trial demonstrated that adding niraparib to abiraterone significantly improves rPFS in patients with BRCA-mutated mCSPC, leading to FDA approval in December 2025. These findings, together with the established role of PARP inhibitors in metastatic mCRPC, highlight the importance of universal somatic testing at the time of metastatic prostate cancer (mPC) diagnosis to guide long-term treatment strategies. We identified variability in institutional genomic testing rates at Miami Cancer Institute (MCI) among patients with prostate cancer and initiated a quality improvement (QI) intervention to improve genomic testing rates. Methods: We initiated a multidisciplinary QI project involving stakeholders from medical oncology, radiation oncology, urologic oncology, and the department of genetics. The primary intervention consisted of a CME-accredited, provider-focused educational program. Clinical knowledge was assessed using a 10-point structured questionnaire developed by institutional genitourinary leadership, in accordance with NCCN and ASCO guidelines, to measure pre- and post-intervention proficiency in genomic testing. In parallel, bilingual patient educational resources were deployed to enhance shared decision-making and patient health literacy. Additionally, institutional practice at the MCI was standardized to implement universal germline testing for all newly diagnosed prostate cancer patients and universal somatic testing for all patients with mPC. Results: Pre-intervention data included 647 patients with metastatic prostate cancer (54.1% Hispanic). Overall, 35.5% underwent somatic genomic testing, with lower utilization among Hispanic vs non-Hispanic patients (31.4% vs 40.1%; χ² = 6.7, p = 0.01). Twenty-eight providers completed the pre-intervention assessment and 21 completed post-intervention. Knowledge of genomic testing improved significantly after the CME intervention (mean Δ 1.38; p = 0.0002), with the largest gains among Surgical Oncology APPs (Δ +1.5) and Radiation Oncology physicians (Δ +1.4). Medical Oncology physicians achieved the highest post-intervention scores (mean 9.3/10). Conclusions: This QI initiative identified a significant ethnic disparity in somatic genomic testing utilization among Hispanic and non-Hispanic patients with mPC at MCI. A CME-based, multidisciplinary educational intervention was associated with improved provider knowledge regarding guideline-concordant genomic testing. Ongoing implementation of universal genomic testing pathways, along with continued patient education, represents a feasible strategy to improve testing uptake and promote equitable access to precision therapies in a diverse patient population served at MCI.