39 Germline Genetic Testing and Disparities In Prostate Cancer: A Dual Analysis of Scientific Literature and Social Variables

Faculty Mentor: Brock O’Neil (Surgery, University of Utah)

Background

Prostate cancer (PCa) is one of the commonly diagnosed malignancies among men in the United States. It originates in the prostate gland, located just below the bladder, which plays a vital role in male reproductive function by producing seminal fluid. In recent years, germline genetic testing (GGT) has become an increasingly important tool used by urologists and other healthcare providers. GGT identifies inherited genetic mutations that may contribute to the development of PCa, enabling more personalized approaches to care.

The use of germline genetic testing has expanded the understanding of prostate cancer’s biological mechanisms, supporting more precise risk assessment, earlier detection, and tailored treatment strategies. However, despite these advancements, significant disparities persist in prostate cancer care. These disparities are evident across multiple dimensions, including access to genetic testing, socioeconomic status (SES), geographical location (rural vs urban communities), and race/ethnicity.

These disparities reflect broader systemic issues in health care access and delivery. This research aims to investigate the intersection of prostate cancer disparities and germline genetic testing, with a focus on understanding how structural and social determinants contribute to unequal outcomes.

Methods

This research was conducted through a comprehensive literature review focused on prostate cancer, particularly its biological aspects and the disparities associated with its diagnosis and treatment. Peer-reviewed articles were identified using academic databases (PubMed, Google Scholar), with specific emphasis on studies addressing racial, socioeconomic, and geographical disparities in prostate cancer outcomes. Priority was given to sources that provided substantial data and analysis, contributing to a broader understanding of the inequities present in prostate cancer care.

In addition to the literature review, in-person clinical shadowing was conducted in both the operating room and the outpatient clinical settings. The hands-on experience provided valuable context to the research by allowing direct observation of prostate cancer care in practice. Shadowing took place at the Huntsman Cancer Institute, offering insight into how prostate cancer care is managed at a major healthcare institution and how care delivery may differ across settings.

Integrating these two methods, literature analysis and clinical exposure, strengthened the research by connecting published data with real-world applications. This dual approach enhanced the interpretation of the literature and offered a more holistic understanding of the multifaceted disparities in prostate cancer care.

Results

This literature revealed a wide array of disparities in prostate cancer and diagnosis, treatment, and outcomes, particularly along racial, socioeconomic, and geographic lines. African Americans (AA) consistently experience higher incidence and mortality rates compared to white men, a trend that is attributed to both biological factors and systemic inequities.^[1] Despite being at higher risk, AA men are significantly underrepresented in GGT. A lack of inclusion can contribute to the lack of trust AA men have in these types of studies, which can also contribute to challenges in reaching out to healthcare professionals and looking for help. This lack of representation contributes to a limited understanding of PCa in this population and perpetuates gaps in personalized care.^[2] The lack of inclusion in clinical trials and studies not only limits the generalizability of existing findings but also contributes to mistrust in the healthcare system. This mistrust, combined with historical injustice in medical research, can discourage AA men from participating in follow-up care or from seeking genetic counseling, even when available³.

Geographic location significantly affects PCa outcomes. Men in rural areas frequently encounter limited access to specialized urologic care, longer travel distances, and fewer screening opportunities. These factors contribute to delayed diagnoses and reduced continuity of care.^[3] Interestingly, while some men in both rural and underserved urban environments receive initial screening, many do not maintain consistent follow-up, increasing the risk of more advanced disease at the time of diagnosis. Although germline genetic testing (GGT) has advanced early detection and personalized treatment, it remains underutilized, particularly among African American men and other marginalized groups. Low referral rates, reduced access to genetic counseling, and a lack of awareness contribute to these disparities. Moreover, some patients initiate testing but do not complete necessary follow-ups, limiting the potential impact of GGT on long-term outcomes.^[4] Socioeconomic status (SES) continues to influence access to prostate cancer care across racial and geographic lines. Lower-income men are less likely to receive routine screenings, early interventions, or genetic testing.^[5] Financial hardship, lack of insurance, and low health literacy are key contributors to this disparity. When compounded with race and geography, SES disparities create a layered burden on vulnerable populations.

Conclusion

This research highlights the persistent and multifaceted disparities in prostate cancer outcomes, particularly as they relate to race, socioeconomic status, geographical location, and access to GGT testing. Through this comparative study, it became evident that African American men continue to face disproportionate burdens in both diagnosis and treatment, while rural populations also experience significant barriers to care. Closing these gaps requires intentional collaboration not only among physicians but across the broader healthcare system, including researchers, policy makers, institutions, and community health advocates. These disparities cannot be addressed if they are not fully acknowledged by the very system that continues to perpetuate them. The healthcare system must recognize and confront the inconsistencies and inequities embedded in medical practice and research. Doing so will be essential in building a more inclusive, responsive, and equitable framework for prostate cancer care.