Closing the HRR testing gap in advanced prostate cancer: Influence of audit-feedback on testing and sustainability.

Abstract

584 Background: NCCN guidelines recommend germline testing and support biomarker-directed somatic homologous recombination repair (HRR) testing for men with high-risk (HR), very high-risk (VHR), regional, and metastatic prostate cancer, yet uptake remains suboptimal. A community oncology practice leveraged existing lung biomarker and breast genetics infrastructure to improve NCCN-concordant testing. Methods: A retrospective chart review of patients eligible for NCCN-concordant germline and/or somatic HRR testing was conducted for 2023 (n=259) and 2024 (n=255) to establish baseline testing rates. Trained reviewers abstracted disease stage, risk group, provider involvement, and testing completion. In 2025, a prostate-specific template, order set, and audit-feedback process were implemented. The 2025 cohort included 170 patients with HR, VHR, regional, or metastatic (M1a–c) disease, of whom 143 (84%) were managed using the prostate-specific template. Results: NCCN-concordant testing improved from 2023 to 2025; germline testing increased from 28% (2023) to 42% (2024) to 63% (2025). Somatic testing increased from 31% (2023) to 43% (2024) to 57% (2025) among eligible pts. In 2025, germline testing remained suboptimal despite NCCN recommendation, with rates of 52% in HR, 63% in VHR, 65% in M1a, and 74% in M1b/c disease. Somatic testing rates were lower in HR and VHR disease (33% and 50%) than in metastatic disease (82% in M1a and 79% in M1b/c). Overall, 107/170 pts (63%) had germline testing and 97/170 (57%) had somatic testing; among non-tested pts, germline gaps were more often due to pt refusal (42/63, 67%), whereas somatic gaps were more often due to physician non-ordering (56/73, 77%). Conclusions: Implementing a prostate-specific template, order set, and audit-feedback process improved germline and somatic homologous recombination repair (HRR) testing rates but left important gaps, particularly among patients with high-risk and very-high risk disease. Higher somatic testing rates in metastatic versus localized high-risk cohorts, together with frequent physician non-ordering, suggest testing perceptions and workflow barriers remain important drivers of completion. Building on our recent work (ASCO 2026, #535732) demonstrating high AI accuracy for prostate cancer staging, risk stratification, and NCCN-concordant testing assignment, these findings support AI-based case identification and prompting to further close testing gaps. 2025 germline and somatic testing rates by specialty. Specialty exposure Germline Somatic Both Med + Rad Onc 16/21 (76.2%) 15/21 (71.4%) Med Onc only 33/52 (63.5%) 40/52 (76.9%) Rad Onc only 58/97 (59.8%) 42/97 (43.3%) Overall 107/170 (62.9%) 97/170 (57.1%)