Bridging the implementation gap in hereditary cancer care for prostate cancer: a narrative review and Japanese environmental scan.
Abstract
Background
Genomic testing has become increasingly important in prostate cancer because BRCA1/2 and other genomic alterations can inform treatment selection and may indicate an underlying hereditary cancer syndrome. However, treatment-directed testing does not necessarily lead to genetic counseling, germline genetic testing, cascade testing, or familial risk management. Prostate cancer therefore presents a unique implementation challenge, particularly in tumor-first testing pathways.
Methods
We conducted a narrative review of international literature on barriers to germline genetic testing and genetic counseling in prostate cancer, an environmental scan of publicly available Japanese sources, and targeted international comparisons of genetics specialist workforce and academic visibility. The findings were integrated into a logic model for hereditary cancer care implementation.
Results
International evidence identified multilevel barriers, including variation in genetic knowledge and training opportunities among urologists, difficulty identifying eligible patients, communication and workflow constraints, limited access to genetics services, financial barriers, low patient awareness, and psychosocial and gender-related factors. The Japanese environmental scan indicated incomplete linkage from tumor genomic testing to genetic counseling, underrepresentation of urologists among genetics specialists, low academic visibility, and limited emphasis on familial risk management in patient materials, guidelines, and education. The logic model highlighted family history assessment, recognition of tumor-first genomic findings, embedded referral pathways, and patient-centered information support as key intervention points.
Conclusions
The implementation gap reflects a structural disconnect between prostate cancer genomics and hereditary cancer care. Pathway redesign may help link tumor genomic testing with germline genetic testing and familial risk management.