Variation in genomic testing amongst localized prostate cancer patients undergoing radical prostatectomy or radiation therapy: Results from a population-based cohort

Genetic testing for prostate cancer is an emerging technology to aid individualized clinical decision-making. Currently, several genetic tests exist with little guidance from clinical practice guidelines. Herein, we sought to assess the use of genetic testing amongst patients with localized prostate cancer and underwent surgery or radiation therapy from a population-based cohort in the U.S.

Using the CancerLinQ database, which captures medical oncology practices across the U.S., we identified all men who received intervention via a radical prostatectomy or radiation therapy for localized prostate cancer (clinical T1-3NxMx and Gleason 6 – 10) from 2015-2023. The primary outcome was use of genetic testing either in the pre-treatment (one year prior to treatment) or post-treatment setting (6 months post-treatment). Multivariable logistic regression analyses were utilized to identify patient and clinical covariates associated with genomic testing utilization.

Amongst the 10,367 patients diagnosed with localized prostate cancer and underwent surgery or radiation therapy, only 247 patients received genetic testing (2.3%) during the study interval. Compared to patients age<50 years, lower odds ratios were observed for patients 50 – 59 years (OR: 0.03; p=0.001), 60 – 69 years (OR: 0.06; p=0.003), 70 – 79 years (OR: 0.01; p<0.001) and>80 years (OR 0.09; p=0.02) on multivariable analysis. Compared to white patients, black patients also had lower odds ratio for genetic testing (OR: 0.09; p=0.03). There were no differences in using genomic testing for surgery versus radiation therapy (OR 1.76; p=0.36).

Over the last decade, the use of genomic testing at the time surgery or radiation therapy for localized prostate cancer remains low and underutilized. Older and black patients were far less likely to receive genetic testing at the time of primary therapy to help inform treatment decisions. Further study is needed to analyze genomic testing use and its role in clinical decision making as it pertains to prostate cancer.