<p><strong> </strong><strong>Clinicians should perform an assessment of patient and tumor risk factors to guide the decision to offer germline testing that includes mutations known to be associated with aggressive prostate cancer and/or known to have implications for treatment. <em>(Expert Opinion)</em></strong></p>
Discussion
Discussion
<p>Germline testing in patients with clinically localized prostate cancer has several potential goals, including enhanced risk stratification, identification of genes that may guide treatment decisions, and providing information to determine the need for personal and family member cancer screening. Identified prostate cancer associated genes to date include <em>ATM, BRCA1, BRCA2, CHEK2, HOXB13, MLH1, MSH2, MSH6, NBN, PALB2, PMS2,</em> and <em>TP53</em>. For example, studies have demonstrated that men with prostate cancer harboring BRCA2 genetic aberrations are more likely to have worse disease and a poorer prognosis.<sup>62</sup> Testing is typically performed via a saliva or blood sample. Patient education, testing, and referral to a genetic counselor should be considered. Establishing specific indications for genetic testing is beyond the scope of this Guideline; indeed, such recommendations have been outlined by a large expert-panel consensus conference.<sup>63</sup> Several of the indications for germline testing are provided in Table 4. Importantly, patient and family history risk factors should be investigated by the clinician through careful history taking, while pathology from biopsy or radical prostatectomy should be reviewed in the consideration of germline testing.</p>
<p><img src="images/Guidelines/Guideline%20Images/2026%20LoPC/LoPC%202026-%20Table%204.png" alt="TABLE 4: Indications for Germline Testing in Patients with Localized Prostate Cancer*" title="TABLE 4: Indications for Germline Testing in Patients with Localized Prostate Cancer*" width="525" height="382" class="blockImg" /></p>