Kalyani Narra, MD, discusses genetic counseling for prostate cancer in a safety-net setting

In this video, Kalyani Narra, MD, discussed the background and key findings of a study examining prostate cancer–related genetic counseling in a safety-net health care setting.

Narra is a general medical oncologist with more than 15 years of experience at JPS Health Network, large safety-net system in Fort Worth, Texas. Unlike large academic centers, JPS operates with a small oncology team and serves a predominantly underserved population, making it an important setting in which to evaluate access to genetic services.

The study was initiated in 2024 when a medical student approached Narra to collaborate on outcomes research in prostate cancer. Leveraging a unique partnership with UT Southwestern, where visiting genetic counselors provide weekly on-site services at JPS, the team conducted a retrospective analysis of 543 prostate cancer patients. The project received IRB approval and was co-authored by key stakeholders involved in the genetic counseling program.

Notable findings highlighted stark differences between this safety-net population and national averages. Forty percent of patients at JPS presented with metastatic prostate cancer, compared with approximately 8% nationally. The cohort was also racially and ethnically diverse: 46% of patients were Black and 27% were Hispanic. Overall, 24% of patients were referred for genetic counseling, and uptake was high—77% completed counseling visits, and 78% of those completed genetic testing. Importantly, about 10% of tested patients had pathogenic genetic findings, potentially qualifying them for targeted therapies such as PARP inhibitors or immunotherapy.

The study also evaluated the impact of the 2018 National Comprehensive Cancer Network guideline changes on referral patterns. Prior to 2018, referrals were rare; none occurred in 2016 and only 4% in 2017. By 2023, referrals had increased sevenfold, with the majority originating from patients with stage IV disease. These findings demonstrate that guideline changes and embedded genetic counseling services can significantly improve access to precision oncology in underserved populations.

REFERENCE

1. Mbonu P, Mersch J, Heady J, et al. Prostate cancer-related genetic counseling in a safety-net healthcare setting. Urol Oncol. 2025 Dec 29:110967. doi: 10.1016/j.urolonc.2025.12.003