Genetic Testing Among Black and White Patients With Advanced Prostate Cancer: A Retrospective Analysis of Testing Utilization and Referral Patterns

Genetic testing uptake in this advanced prostate cancer cohort was low overall. Notably, Black patients had higher rates of somatic testing, an equitable finding given historically higher prostate cancer-specific mortality. Germline testing was comparable overall but remained lower among Black patients with metastatic disease, indicating that additional decisional and systemic barriers persist beyond access to care and referrals to genetic counseling. Insurance disparities and lower census tract-estimated income represent the largest structural differences between cohorts, with observed equity likely supported by broad coverage of commercial testing. Together, these results indicate that equitable testing utilization is achievable through consistent access frameworks, while residual disparities in germline testing warrant targeted intervention at both the patient and healthcare delivery levels.