Genetic Testing for Prostate Cancer: Trends in Hereditary Cancer Screening & Ultrasound Use

This study explores the trends in germline genetic testing (GGT) for prostate cancer, focusing on the increased responsibility of non-genetics providers in ordering tests. With the expansion of targeted therapies for advanced prostate cancer, national guidelines now recommend GGT for all patients with high-risk localized and advanced disease. The researchers hypothesized that urologists, given their central role in prostate cancer management, would increasingly be ordering these tests. The analysis was based on a cohort of 17,256 prostate cancer patients who underwent GGT from 2015 to 2020, facilitated by a single commercial laboratory (Invitae Corporation). Among the 14,400 patients with identifiable ordering providers, the data revealed a sharp increase in GGT orders, from 142 in March 2015 to 5,808 by December 2020. The proportion of tests ordered by urologists rose significantly, from 0% in 2015 to 8.3% by 2020. Notably, urologists were more likely to order GGT for patients under 70 years old (66%) and those with a negative family history (25%) compared to other specialties, such as medical genetics and oncology. The results underscore the growing involvement of urologists in genetic testing, aligning with the broader trend of expanding indications for GGT. As the role of GGT in prostate cancer management continues to grow, there is an increasing need for educational resources to inform urologists about genetic testing indications, ultrasound integration for screening, and access to genetic counseling for post-test support. These findings highlight the importance of equipping healthcare providers with the necessary tools to integrate GGT effectively into clinical practice.