Real-World Data Highlight Trends in HRR Genetic Testing Equity in Metastatic Prostate Cancer

The treatment landscape for metastatic prostate cancer is rapidly reshaping through advances in precision oncology, specifically through the expansion of homologous recombination repair (HRR) in genetic testing to identify patients eligible for targeted therapies. While racial disparities in prostate cancer incidence and mortality are persistently well documented, emerging real-world data indicates that equitable access to HRR testing has the potential to be increasingly achievable within community oncology settings utilizing integrated electronic health record (EHR) infrastructure.¹

Temporal trends in HRR genetic testings were recently evaluated by researchers from Ontada amongst patients with metastatic prostate cancer from 2015 through 2024, including differences in testing patterns by race within a large US community oncology network. Pharmacy Times spoke with Helen Latimer, MPH, the senior observational researcher of Ontada. In the interview, Latimer explained that these findings reflect advancements in precision oncology and broader improvements in clinical technology integration simultaneously.

The Growing Importance of HRR Testing in Prostate Cancer

The rise in biomarker-driven oncology is progressively becoming crucial in metastatic prostate cancer with the continuous shift in treatment strategies towards more personalized approaches.² HRR gene alterations—such as BRCA mutations—are associated with sensitivity to poly (ADP-ribose) polymerase (PARP) inhibitor therapies, which have displayed improved clinical outcomes in select patient populations.^3,4

“Treatment decisions are increasingly based off of these molecular characteristics, and I think that's especially true in metastatic prostate cancer as well,” Latimer said in the interview.

Clinicians are able to identify patients who may benefit from targeted therapies earlier in the treatment journey with the incorporation of HRR testing into routine oncology practice. Timely testing is critical to avoiding missed treatment opportunities among patients with advanced disease, as expressed by Latimer.

“We know from clinical trials that these PARP inhibitor-based therapies are best suited for patients with these HRR alterations,” she explained. “These patients respond particularly well to these targeted therapies with improved survival.”

Increased Uptake of Genetic Testing in Community Oncology

According to the data discussed by Latimer, a substantial increase in HRR genetic testing over the study period was demonstrated. The testing rates remained approximately 5% or lower among patients with metastatic prostate cancer prior to 2019; however, testing rates increased significantly beginning in 2020 and peaked at approximately 40% in both 2023 and 2024.

Latimer explained that these findings reflect not only broader access to testing, but also improvements in EHR integration and documentation capabilities within community oncology practices.

“We are seeing that patients are accessing genetic testing more broadly in the community setting,” Latimer stated. “Technology is improving over time, and that's able to help improve equity to access to genetic testing, and hopefully to these targeted treatments as well.”

Crucially, the data demonstrated that HRR testing rates among Black and White patients were largely aligned throughout much of the study period. Given the longstanding disparities in prostate cancer outcomes, this finding was considered particularly encouraging.

How Technology May Help Reduce Testing Disparities

Compared with White patients, Black men continuously experience disproportionately higher prostate cancer mortality rates and are often diagnosed at later disease stages.⁵ While biologic factors should be taken into consideration as they may contribute to these differences, inequities in access to care, diagnostics, and treatment remain important drivers of poor outcomes.

Latimer emphasized that integrated EHR systems can potentially help address some of these barriers through embedding standardized clinical pathways directly into oncology workflows.

“There is a huge opportunity with the technology that we have,” Latimer explained. “Using EHR not only to document treatment characteristics and diagnosis information, but to incorporate clinical pathways actually into the structured EHR to provide education for patient and provider alike.”

Latimer added that standardized documentation and testing protocols can help minimize bias, reduce duplicate testing, and improve communication across multidisciplinary care teams. The findings further highlight the importance of continued collaboration between pharmacists, oncologists, genetic specialists, and health systems in order to ensure equitable implementation of precision medicine initiatives across diverse patient populations.

“Equitable testing is achievable,” Latimer said, particularly within community oncology settings utilizing integrated infrastructure and standardized processes.

REFERENCES

1. American Cancer Society. Key statistics for prostate cancer. Updated January 17th, 2025. Accessed May 19th, 2026. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html

2. National Cancer Institute. Precision medicine in cancer treatment. Updated February 24th, 2023. Accessed May 19th, 2026. https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment

3. National Cancer Institute. With Two FDA Approvals, Prostate Cancer Treatment Enters the PARP Era. June 11th, 2020. Accessed May 19th, 2026. https://www.cancer.gov/news-events/cancer-currents-blog/2020/fda-olaparib-rucaparib-prostate-cancer

4. de Bono J, Mateo J, Fizazi K, et al. Olaparib for Metastatic Castration-Resistant Prostate Cancer. N Engl J Med. 2020;382(22):2091-2102. doi:10.1056/NEJMoa1911440

5. American Cancer Society. Cancer facts and figures for African American/Black people 2024-2026. Accessed May 19th, 2026. https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html