Comparison of Characteristics and Outcomes of Patients With Metastatic Prostate Cancer With and Without Next-Generation Sequencing Testing

PURPOSE Next-generation sequencing (NGS) is recommended for patients with metastatic prostate cancer (PC). Nationwide, testing rates are low. Whether PC disease characteristics and courses differ between those with and without NGS testing is unknown. We identified predictors of testing, explored likely reasons for lack of testing, and compared survival between those with and without testing. METHODS We retrospectively reviewed patients with metastatic PC initially seen between 2020 and 2022 at Johns Hopkins. Clinical data and reasons for nontesting were abstracted from the electronic medical record. We conducted a logistic regression assessing predictors of NGS testing, adjusting for age, Gleason grade, marital status, and metastatic diagnosis year. We used Cox regression to compare overall survival, defined from the time patients had both a metastatic diagnosis and a visit at our institution until death/last follow-up, between those tested and not tested. We adjusted for age, Gleason grade, initial metastasis (M) stage, comorbidities, and time from metastatic diagnosis to first visit. RESULTS Of the 435 patients, 257 (59%) had NGS testing. Older patients were less likely to have testing (adjusted odds ratio aOR, 0.96 95% CI, 0.94 to 0.98). Unmarried patients were less likely to have testing (aOR, 0.62 95% CI, 0.38 to 1.01). Patients with Gleason Grade Group 5 were more likely to undergo testing than patients with Groups 1-3 (aOR, 1.86 95% CI, 1.14 to 3.04). Among those without testing, 139 (78%) had at least one potential reason for lack of testing in the medical record. The most common reason for nontesting was patient/disease factors (37%). CONCLUSION Older and unmarried men with metastatic PC were less likely to obtain NGS testing, whereas those with high Gleason grade were more likely. Interventions are needed to improve testing rates.