The Role of Genetic Testing in Localized Prostate Cancer

Genetic testing is increasingly central to the management of localized prostate cancer (PCa). Advances in next-generation sequencing have revealed both germline and somatic alterations that influence disease risk, prognosis, and therapeutic response. Approximately 10% to 15% of men with PCa carry pathogenic germline variants, most commonly in BRCA2, ATM, CHEK2, HOXB13, and mismatch repair genes. Consensus recommendations and guidelines now endorse routine germline testing in men with high-risk localized disease, strong family history, or known familial mutations. Germline information, as well as somatic genomic classifiers, is increasingly being used to help guide screening and treatment recommendations.