Genetic Testing Rates Increasing Among Veterans With Metastatic Prostate Cancer

Key Clinical Summary 

• Only 16% of veterans with metastatic castration-resistant prostate cancer (mCRPC) received hereditary cancer genetic testing between 2016-2021. 

• Rates of testing increased sharply in 2020-2021, coinciding with expansion of US Veterans Affairs (VA) precision oncology initiatives. 

• Genetic counseling and care at specialized VA centers significantly increased likelihood of testing. 

A new VA study highlights rising but still limited use of hereditary cancer genetic testing among veterans with mCRPC. The retrospective cohort analysis, spanning 2016-2021, used structured and unstructured electronic health record (EHR) data to assess utilization patterns and identify factors associated with testing. Findings underscore both progress and persistent disparities in implementing precision oncology within the US veteran population. 

Study Findings 

Among 9703 veterans with mCRPC who did not decline testing, only 16% underwent hereditary cancer genetic testing. Nearly one-half of these tests were conducted in 2020-2021, reflecting rapid adoption of genetic services in recent years. 

Genetic counseling was the strongest predictor of testing, with an adjusted odds ratio (aOR) of 11.07 (95% CI, 3.66-33.51). Veterans enrolled in clinical trials were also far more likely to be tested (aOR, 7.42; 95% CI, 5.59-9.84). Treatment at a Prostate Cancer Foundation–Veterans Affairs Center of Excellence (PCF–VA COE) modestly increased testing likelihood (aOR, 1.43; 95% CI, 1.04-1.95]. 

In contrast, older age (aOR, 0.95 [95% CI; 0.93-0.97]) and severe comorbidity (aOR, 0.82; 95% CI, 0.71-0.94) were associated with lower testing rates. The study found that the time from diagnosis to testing decreased tenfold by 2021 compared with 2016, while the median age at testing rose yearly, indicating both improved timeliness and evolving eligibility practices. 

Investigators attributed the uptick in testing to guideline updates, increased access through the VA National Precision Oncology Program (NPOP), and the expansion of PCF–VA Centers of Excellence. 

Clinical Implications 

Hereditary genetic testing is a cornerstone of precision oncology, identifying patients who may benefit from targeted therapies and informing family cancer risk. Despite evidence-based recommendations, testing rates among veterans remain suboptimal, suggesting missed opportunities for individualized care. 

The VA’s ongoing efforts to integrate genetic testing into routine prostate cancer management via programs like NPOP and PCF–VA COEs are crucial to bridging these gaps. Clinicians treating veterans should consider systematic referral to genetic counseling and testing, particularly for patients with advanced or familial disease risk. Enhancing patient education, clinician training, and EHR-based reminders may further improve uptake. 

“Although genetic testing within the VA remains low, this recent temporal increase in testing rates and age reflects advances in practice guidelines, coverage by the VA National Precision Oncology Program, and the growing rollout of the PCF–VA Centers of Excellence,” the authors noted. 

Conclusion 

Testing rates for hereditary cancer genes among veterans with mCRPC have risen markedly since 2016 but remain below optimal levels. Continued clinician engagement, patient education, and precision oncology infrastructure are essential to ensure equitable access and improved cancer outcomes for US veterans. 

Reference 

Candelieri-Surette D, Hung A, Agiri FY, et al. Incorporating structured and unstructured data sources to identify and characterize hereditary cancer testing among veterans with metastatic castration-resistant prostate cancer. JCO Clin Cancer Inform. 2025;9:e2400189. doi:10.1200/CCI-24-00189