Community voices, strategies to improve understanding, and access to prostate cancer genomic testing.

Abstract

Community voices highlight opportunities to improve understanding and access to prostate cancer genomic testing; however, uptake remains limited, particularly among racially and geographically diverse populations. This study explored community perceptions of prostate cancer genomic testing and identified barriers, facilitators, and communication priorities to inform culturally responsive, literacy-sensitive education strategies. In this study, we focus specifically on tissue-based genomic testing used to inform treatment decision-making, rather than cancer screening or inherited genetic risk assessment. We conducted a qualitative, phenomenological study using a community-based participatory research approach with multi-site Community Advisory Boards (CABs) in Florida, Arizona, and Minnesota (June 2023-March 2024). Across eight focus groups, 31 participants, including prostate cancer survivors, caregivers, clinicians, and community advocates, shared perspectives on genomic testing and preferences for educational materials. Discussions were conducted in English, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis guided by Braun and Clarke's six-phase approach. Participants demonstrated limited awareness of genomic testing and frequently conflated it with ancestry or hereditary testing. Engagement was shaped by fear, stigma, masculine identity norms, and structural barriers, including cost and healthcare access. Caregivers were described as central to decision-making, while trust in information sources strongly influenced receptivity to genomic testing. Participants emphasized the need for clear, culturally relevant communication delivered by trusted community messengers and supported by family-inclusive approaches. Community perspectives suggest that improving access to prostate cancer genomic testing requires more than increasing availability; it requires addressing gaps in understanding, trust, and structural access. Community-informed, culturally grounded strategies may support more equitable implementation of precision oncology.