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Using Dutch national incidence data, predefined healthcare cost frameworks, and a hypothetical assumption for the acceptance rate of patients, we modelled total costs for the Netherlands and number of identified pathogenic variants for each approach. The costs of genetic testing and post-test counselling decreased threefold when applying selection criteria, compared to the scenario where all metastatic prostate cancer patients are eligible. However, applying selection criteria would result in missing 41% clinically relevant pathogenic germline variants that would otherwise be identified. This implies that, at national level, a discussion should be started regarding willingness to pay for identifying pathogenic germline variants.<\/jats:p>","DOI":"10.1007\/s00439-026-02854-1","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T03:17:37Z","timestamp":1787973457000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expected costs and benefits of genetic counselling and germline genetic testing in metastatic prostate cancer"],"prefix":"10.1007","volume":"145","author":[{"given":"Michiel","family":"Vlaming","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lambertus A. L. 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