{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T17:50:13Z","timestamp":1782237013618,"version":"3.54.5"},"reference-count":31,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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\u201306\/2025), assessing demographics, qualifications, and GT behavior. Cochran-Armitage test for trend and Fisher\u2019s 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\u20130.79, p = 0.004). GeT did not differ significantly by experience (OR 0.90 per career stage, 95% CI 0.56\u20131.46, p = 0.67). Neither gender (OR 0.74, 95% CI 0.31\u20131.74), nor having a qualification in urological cancer-specific genetic counseling (26.5% of respondents; OR 0.81, 95% CI 0.33\u20131.98) 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.<\/jats:p>","DOI":"10.3390\/cancers18132030","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T17:11:49Z","timestamp":1782234709000},"page":"2030","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of Genetic Testing in Prostate Cancer: A Real-World Survey of Outpatient Urologists in Germany (PRO-GEN)"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5705-4839","authenticated-orcid":false,"given":"Julia C.","family":"Kaulfuss","sequence":"first","affiliation":[{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Urology, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7035-9127","authenticated-orcid":false,"given":"Jonathan","family":"Jeutner","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Urology, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Erber","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Urology, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Siech","sequence":"additional","affiliation":[{"name":"Goethe University Frankfurt, University Hospital, Department of Urology,  60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Wenzel","sequence":"additional","affiliation":[{"name":"Goethe University Frankfurt, University Hospital, Department of Urology,  60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix K. H.","family":"Chun","sequence":"additional","affiliation":[{"name":"Goethe University Frankfurt, University Hospital, Department of Urology,  60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Hellmis","sequence":"additional","affiliation":[{"name":"Urologicum Duisburg, 47169 Duisburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1163-1401","authenticated-orcid":false,"given":"Christian P.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Ruhr-University Bochum, Herford Hospital, Department of Urology, 32049 Herford, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Schlomm","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Urology, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4969-0877","authenticated-orcid":false,"given":"Maria","family":"De Santis","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Urology, 10117 Berlin, Germany"},{"name":"Medizinische Universit\u00e4t Wien, Department of Urology,  1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2939-5347","authenticated-orcid":false,"given":"Nadine","family":"Biernath","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Department of Urology, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Elmadani, M., Mokaya, P.O., Omer, A.A.A., Kiptulon, E.K., Klara, S., and Orsolya, M. (2025). Cancer burden in Europe: A systematic analysis of the GLOBOCAN database (2022). BMC Cancer, 25.","DOI":"10.1186\/s12885-025-13862-1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1056\/NEJMoa1603144","article-title":"Inherited DNA-Repair Gene Mutations in Men with Metastatic Prostate Cancer","volume":"375","author":"Pritchard","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2980","DOI":"10.1002\/cncr.32908","article-title":"Germline and somatic DNA repair gene alterations in prostate cancer","volume":"126","author":"McPherson","year":"2020","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"469","DOI":"10.6004\/jnccn.2025.0052","article-title":"Prostate Cancer, Version 3.2026, NCCN Clinical Practice Guidelines in Oncology","volume":"23","author":"Spratt","year":"2025","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_5","unstructured":"(2026). EAU Guidelines. Edn. Presented at the EAU Annual Congress London 2026, EAU Guidelines Office. Available online: http:\/\/uroweb.org\/guidelines\/compilations-of-all-guidelines\/."},{"key":"ref_6","unstructured":"Leitlinienprogramm Onkologie (2025). S3 Leitlinie Prostatakarzinom, Version 8.1\u2014August 2025, Leitlinienprogramm Onkologie."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1111\/ajco.13148","article-title":"Outcomes of universal germline testing for men with prostate cancer in an Australian tertiary center","volume":"15","author":"Crumbaker","year":"2019","journal-title":"Asia Pac. J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1038\/s41391-022-00609-3","article-title":"Germline mutations in prostate cancer: A systematic review of the evidence for personalized medicine","volume":"26","author":"Marino","year":"2023","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1001\/jamaoncol.2018.6760","article-title":"Prevalence of Germline Variants in Prostate Cancer and Implications for Current Genetic Testing Guidelines","volume":"5","author":"Nicolosi","year":"2019","journal-title":"JAMA Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s00120-022-01915-3","article-title":"Promoting women in urology using the example of habilitation","volume":"61","author":"Welte","year":"2022","journal-title":"Urologie"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1080\/14796694.2025.2470616","article-title":"Real-world treatment patterns and genetic testing in a metastatic castration-resistant prostate cancer setting in Europe","volume":"21","author":"Castro","year":"2025","journal-title":"Future Oncol."},{"key":"ref_12","first-page":"100212","article-title":"Knowledge and practice regarding prostate cancer germline testing among urologists: Gaps to address for optimal implementation(\u2730,\u2730\u2730)","volume":"25","author":"Loeb","year":"2020","journal-title":"Cancer Treat. Res. Commun."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/bju.16462","article-title":"Impact of homologous recombination repair\/BReast CAncer (BRCA) gene alterations on survival in a real-world setting of metastatic prostate cancer","volume":"135","author":"Wenzel","year":"2025","journal-title":"BJU Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1056\/NEJMoa2022485","article-title":"Survival with Olaparib in Metastatic Castration-Resistant Prostate Cancer","volume":"383","author":"Hussain","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/S0140-6736(25)00683-X","article-title":"Talazoparib plus enzalutamide in men with HRR-deficient metastatic castration-resistant prostate cancer: Final overall survival results from the randomised, placebo-controlled, phase 3 TALAPRO-2 trial","volume":"406","author":"Fizazi","year":"2025","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4109","DOI":"10.1038\/s41591-025-03961-8","article-title":"Niraparib and abiraterone acetate plus prednisone for HRR-deficient metastatic castration-sensitive prostate cancer: A randomized phase 3 trial","volume":"31","author":"Attard","year":"2025","journal-title":"Nat. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5334","DOI":"10.1002\/cncr.26166","article-title":"Reported referral for genetic counseling or BRCA 1\/2 testing among United States physicians: A vignette-based study","volume":"117","author":"Trivers","year":"2011","journal-title":"Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.ypmed.2014.08.004","article-title":"Patient and physician gender concordance in preventive care in university primary care settings","volume":"67","author":"Virgini","year":"2014","journal-title":"Prev. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1056\/NEJM199308123290707","article-title":"Preventive care for women. Does the sex of the physician matter?","volume":"329","author":"Lurie","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1200\/JCO.19.02960","article-title":"Germline and Somatic Tumor Testing in Epithelial Ovarian Cancer: ASCO Guideline","volume":"38","author":"Konstantinopoulos","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.ygyno.2020.11.003","article-title":"Embedding a genetic counselor into oncology clinics improves testing rates and timeliness for women with ovarian cancer","volume":"160","author":"Rana","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100802","DOI":"10.1016\/j.gim.2023.100802","article-title":"Implementing digital systems to facilitate genetic testing for hereditary cancer syndromes: An observational study of 4 clinical workflows","volume":"25","author":"Wang","year":"2023","journal-title":"Genet. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1002\/pros.24480","article-title":"Utilization of genetic testing in men with advanced prostate cancer","volume":"83","author":"Aguiar","year":"2023","journal-title":"Prostate"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1097\/UPJ.0000000000000352","article-title":"Attitudes, Perceptions, and Use of Cancer-based Genetic Testing Among Healthy U.S. Adults and Those with Prostate or Breast\/Ovarian Cancer","volume":"10","author":"Thakker","year":"2023","journal-title":"Urol. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e773","DOI":"10.1200\/OP.22.00638","article-title":"Implementation of a Telehealth Genetic Testing Station to Deliver Germline Testing for Men with Prostate Cancer","volume":"19","author":"Kwon","year":"2023","journal-title":"JCO Oncol. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2798","DOI":"10.1200\/JCO.20.00046","article-title":"Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019","volume":"38","author":"Giri","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1200\/PO.21.00238","article-title":"Pretest Genetic Education Video Versus Genetic Counseling for Men Considering Prostate Cancer Germline Testing: A Patient-Choice Study to Address Urgent Practice Needs","volume":"5","author":"Russo","year":"2021","journal-title":"JCO Precis. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13053-024-00298-0","article-title":"Validation of a guidelines-based digital tool to assess the need for germline cancer genetic testing","volume":"22","author":"Russell","year":"2024","journal-title":"Hered. Cancer Clin. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"321","DOI":"10.5489\/cuaj.7954","article-title":"Recommendations for the implementation of genetic testing for metastatic prostate cancer patients in Canada","volume":"16","author":"Selvarajah","year":"2022","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"135","DOI":"10.47102\/annals-acadmedsg.2022372","article-title":"An approach to genetic testing in patients with metastatic castration-resistant prostate cancer in Singapore","volume":"52","author":"Kanesvaran","year":"2023","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e204","DOI":"10.1200\/OP.20.00399","article-title":"Evaluation of a Mainstream Model of Genetic Testing for Men with Prostate Cancer","volume":"17","author":"Scheinberg","year":"2021","journal-title":"JCO Oncol. Pract."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/13\/2030\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T17:24:44Z","timestamp":1782235484000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/13\/2030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,23]]},"references-count":31,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["cancers18132030"],"URL":"https:\/\/doi.org\/10.3390\/cancers18132030","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,23]]}}}