Improving Genetic Testing Uptake in Prostate Cancer: Outcomes From a Multidisciplinary Clinic Evaluation

PURPOSE The National Comprehensive Cancer Network recommends germline genetic testing for patients with prostate cancer and high-risk features or a suggestive family history. In 2024, the University of Colorado Urological Oncology Multidisciplinary Clinic (MDC) transitioned from a referral-based to a mainstream genetic testing model to streamline access and improve completion rates. We report the impact of this implementation on genetic testing uptake and subsequent genetic counseling recommendations. METHODS The impact of a quality improvement initiative implemented in 2024 was assessed by comparing patients with prostate cancer evaluated at the urologic oncology MDC in consecutive years. In 2024, patients seen in MDC who met criteria for genetic testing were offered testing with a mainstream genetic testing model. These patients were then compared with eligible patients who were seen in 2023 when a traditional referral-based testing model was used. RESULTS A total of 432 patients were evaluated (190 in 2023, 242 in 2024). Of those, 112 patients in 2023 and 115 patients in 2024 met eligibility criteria. Completion of genetic testing increased significantly from 30% (34/112) in 2023 to 72% (83/115) in 2024 ( P < .001). Among patients tested with the mainstream model in 2024, pathogenic variants were identified in 10 (12%) individuals. Seven of 10 patients with pathogenic variants completed post-test genetic counseling, where cascade testing and preventive screening recommendations were discussed. CONCLUSION Transitioning to a provider-initiated, mainstream genetic testing model significantly improved pretest genetic testing completion rates within a multidisciplinary prostate cancer clinic. This integrated approach enhanced care coordination and expedited genetic evaluation, potentially representing a scalable framework to expand precision oncology and hereditary cancer risk assessment in prostate cancer management.