Adherence to Germline Testing and Provider Patterns in Eligible Men With Prostate Cancer at an Urban Cancer Center

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

NTRODUCTION AND OBJECTIVES: Germline pathogenic variants have important implications in the management of prostate cancer (PC), influencing treatments, and familial risk counselling. Various pathogenic variants, particularly those related to hereditary cancer syndromes such as BRCA1, BRCA2, ATM, PALB2, and MLH1have been linked to aggressive disease. The National Comprehensive Cancer Network (NCCN) recommends germline testing (GT) for patients with metastatic PC, high risk or very high risk localized PC, or family history of cancer suggestive of hereditary cancer syndromes. However, adherence to guidelines in clinical practice remains variable. We aimed to evaluate compliance to NCCN guidelines for GT among eligible PC patients, identify specialists most likely to order testing, and evaluate GT outcomes. METHODS: This is a retrospective review evaluating GT utilization among PC patients at the Karmanos Cancer Center genitourinary clinics (KCCGC), Detroit, MI. Our objectives were to determine the rates and results of GT and to identify factors associated with the likelihood of undergoing GT. Our study defined GT eligibility based on personal or family history of hereditary cancer, metastatic disease, or PSA levels greater than 20 ng/mL. RESULTS: Data was collected from January 2021, to March2023. We identified 702 patients with PC, of whom 412 met the eligibility criteria for GT. Among the 412 people, 128 (31%) received GT by KCCGC providers. Out of 128 GT administered, 88 (69%) were ordered by medical oncologists, with the remainder ordered by urologists and radiation oncologists. Among the 412 patients who met the criteria for GT, the median PSA and age at time of PC diagnosis were 99 ng/mL and 64 years old respectively, and 189 (46%) had metastatic cancer. Of those tested, 28 had a pathogenic variant, 26 had a likely pathogenic variant, 21 had a variant of unknown significance, and 53 had negative or no actionable variants. CONCLUSIONS: This analysis displayed a notable gap in NCCN guideline adherence for GT among PC patients, with only 31% of eligible patients receiving GT. Furthermore, the majority of tests were ordered by medical oncologists, suggesting a variation in specialist familiarity or willingness to order GT. The lack of guideline compliance suggests a potential missed opportunity for targeted therapies for individuals with specific pathogenic variants and counselling for families of individuals for earlier screening. These findings emphasize a need to implement standardized ordering forms and education initiatives for patients and providers regarding appropriate implementation of GT in PC patients.

Volume

215

Issue

5S

First Page

e1519

Last Page

e1519

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

DOI

10.1097/01.JU.0001191740.08299.b6.12

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