OBJECTIVES: To investigate real-world homologous recombination repair mutation (HRRm) testing patterns in patients with metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (mCRPC), and barriers to testing

METHODS: Data were drawn from the Adelphi Real World Prostate Cancer (PC) Disease Specific Programme™, a cross-sectional survey with retrospective data collection of physicians and their patients with mHSPC and mCRPC in France, Germany, Italy, Spain, and the United Kingdom from November 2022 – May 2023. Physicians completed surveys for consecutively consulting patients (four mHSPC, eight mCRPC), reporting demographics, clinical characteristics, testing patterns and testing barriers. Patients with no clinical trial experience and PC as their only malignancy were included. HRR genes of interest were: BRCA1, BRCA2, ATM, BRIP1, BARD1, CDK12, CHEK1, CHEK2, FANCL, PALB2, RAD51B, RAD51C, RAD51D, RAD54L. Analyses were descriptive.

RESULTS: Overall, 221 physicians (84% medical oncologists, 16% urologists) reported data for 2612 patients (mHSPC n=875, mCRPC n=1737). For patients with mHSPC/mCRPC respectively, median (interquartile range; IQR) age was 71.0 (66.0–77.0)/73.0 (68.0–78.0) years, and 81%/77% had an ECOG PS score of 0–1.

Of mHSPC patients, 25% (n=223) received a HRRm test (HRRm-positive: 35%). Of tested patients, 77% tested for only BRCA1/2 (BRCA1/2-positive: 34%). Seventy-five percent of HRRm tests were conducted at metastatic PC diagnosis. Of tested patients, 22% had family history of cancer.

Of mCRPC patients, 37% (n=640) received a HRRm test (HRRm-positive: 32%). Of tested patients, 73% tested for only BRCA1/2 (BRCA1/2-postive: 31%). Forty-two percent of HRRm tests were conducted at castration-resistance/progression following mHSPC treatment. Of tested patients, 19% had family history of cancer.

Physician-reported barriers to genetic testing included high cost (37%) and lack of reimbursement (32%).

CONCLUSIONS: HRRm testing remains limited in patients with mHSPC/mCRPC. Addressing reimbursement and cost would encourage broader/earlier testing, allowing timely identification of patients who might benefit from personalised treatments.