Assessing germline genetic testing patterns, awareness, and adherence to guidelines among lebanese prostate cancer patients

Abstract Introduction: Prostate cancer is the most common cancer in men worldwide and the second most lethal after lung cancer. Despite poor prognosis for metastatic cases, treatment advances have extended survival. However, data on germline genetic testing in Lebanese prostate cancer patients is scarce. This study investigates the frequency and role of genetic testing in prostate cancer management in Lebanon, focusing on its impact on treatment decisions. Methods Pathogenic variant status was assessed using an NGS panel. Data from the Saint Joseph University genetic lab (2013–2022) was analyzed, including demographics, diagnosis year, testing dates, and treatment outcomes. Referral patterns between oncologists and urologists were compared, and the use of PARP inhibitors was discussed. Results Only 20 patients were referred for genetic testing over 12 years. Our study's low referral rates reflect real-world data from a third-country setting. Among these, 15% were referred by urologists and 85% by oncologists. Of those tested, 20% were positive, two with BRCA2 mutations and two with MSH2 variants. Testing was mostly done after disease progression or metastasis, four were referred due to family history. None of the positive patients received PARP inhibitors. Conclusion The study revealed low genetic testing referral rates, consistent with global trends despite updated guidelines. Contributing factors include complex guidelines, limited provider awareness, and high testing costs. Interestingly, these factors are more pronounced in the context of our study. Improved education, clearer guidelines, and telemedicine access could boost genetic testing uptake, enhancing prostate cancer treatment standards and survival rates locally and globally, with a particular focus on developing countries including Lebanon.