Integrating Broad Panel Somatic and Germline Testing in Prostate Cancer Care

Introduction: Genetic testing, including germline and tumor testing, using broad panel-based approaches has transformed treatment strategies for metastatic prostate cancer. Despite guideline consensus that all men with metastatic prostate cancer should undergo tumor testing to identify mutations, suboptimal testing rates diminish the impact genetic testing can have on diagnosis, prognosis, and treatment decisions. This article outlines the various barriers to clinical adoption and implementation of broad panel genetic testing in the prostate cancer care continuum and opportunities for addressing these challenges. Methods: A landscape assessment and literature review were conducted across medical databases as well as oncologic and urologic websites to assess the current guidelines and state of broad panel genetic testing in prostate cancer. Results: There are numerous barriers and clinical practice gaps that hinder implementation and integration of broad panel somatic and germline testing in prostate cancer clinical care. Identified areas of concern include patient identification, test ordering considerations, cost and payer coverage, sample collection, genetic education and interpretation of test results, and social inequities. These barriers have prevented guideline concordance and optimal care for patients with prostate cancer. Conclusions: Overall outcomes significantly improve for patients whose treatments are tailored to findings from genetic testing. The development of comprehensive care pathways that close clinical care gaps is necessary to ensure the continued optimization of broad panel genetic testing.