Implementation of Genetic Testing in Prostate Cancer: A Real-World Survey of Outpatient Urologists in Germany (PRO-GEN).

Background/Objectives: Genetic testing (GT) is essential for precision therapy in prostate cancer (PC). Implementation in routine outpatient cancer care remains heterogeneous. We assessed real-world data on GT practices among German Outpatient Urologists (GOUs) to identify strategies for improvement. Methods: A nationwide, multi-center survey was conducted among GOUs in Germany (02-06/2025), assessing demographics, qualifications, and GT behavior. Cochran-Armitage test for trend and Fisher's exact test were used to assess associations; odds ratios with 95% confidence intervals were estimated using binary logistic regression. Results: In total, 117 GOUs participated, all practiced in outpatient settings. GT differed by disease stage: in localized prostate cancer, 6.0% reported ordering somatic testing (SoT) and 8.5% germline testing (GeT), compared to 67.5% and 42.7%, respectively, in metastatic disease. Overall, 29.1% reported not ordering GT of any kind. Ordering SoT for metastatic disease was significantly lower among senior physicians compared to early- and mid-career physicians (43% vs. 78% and 74%; OR 0.46 per career stage, 95% CI 0.27-0.79, p = 0.004). GeT did not differ significantly by experience (OR 0.90 per career stage, 95% CI 0.56-1.46, p = 0.67). Neither gender (OR 0.74, 95% CI 0.31-1.74), nor having a qualification in urological cancer-specific genetic counseling (26.5% of respondents; OR 0.81, 95% CI 0.33-1.98) was significantly associated with testing. BRCA1 and BRCA2 were recognized by 96.6% of respondents. Knowledge of other PC-associated genes was much lower. Conclusions: Despite guideline recommendations, GT, particularly GeT, remains underutilized in PC care in Germany. Senior physicians tested significantly less, and gene knowledge beyond BRCA1/2 was limited.