Genomic Testing Variations in Localized Prostate Cancer: Insights on Radical Prostatectomy, Radiation, and Ultrasound

Genomic testing is an emerging tool for individualized clinical decision-making in prostate cancer management, but its utilization remains low. This study analyzed data from the CancerLinQ database, focusing on 10,367 men diagnosed with localized prostate cancer (clinical T1-3NxMx, Gleason 6-10) who underwent radical prostatectomy or radiation therapy between 2015 and 2023. Despite its potential to guide treatment, only 247 patients (2.3%) received genetic testing either pre-treatment (within one year prior) or post-treatment (within six months). Multivariable logistic regression revealed significant disparities in testing rates. Older patients were far less likely to undergo genomic testing compared to those under 50 years old, with odds ratios significantly declining across age groups: 50-59 years (OR: 0.03), 60-69 years (OR: 0.06), 70-79 years (OR: 0.01), and over 80 years (OR: 0.09). Additionally, black patients had lower odds of receiving genetic testing compared to white patients (OR: 0.09), highlighting racial disparities in access to this advanced diagnostic tool. Interestingly, there was no significant difference in testing rates between patients undergoing surgery versus radiation therapy (OR: 1.76; p=0.36). These findings suggest a significant underutilization of genomic testing in localized prostate cancer treatment, particularly among older and black patients, despite its potential benefits in optimizing therapy decisions. The lack of widespread adoption underscores the need for further research to explore barriers to access and to clarify the role of genomic testing in clinical guidelines. Addressing these gaps could enhance personalized care and improve outcomes in prostate cancer management.