Box 1: NCCN Guideline Recommendations for Germline Genetic Testing in Prostate Cancer

Germline mutations should be tested in all newly diagnosed men with NCCN high-risk, very high-risk, regional, or metastatic prostate cancer, regardless of family history and also for every patient with high-risk, localized non-metastatic prostate cancer. Germline testing is suggested for the following genes: BRCA1, BRCA2, ATM, PALB2, CHEK2, MLH1, MSH2, MSH6, and PMS2, using NGS panel testing. Family history of high-risk germline mutations (e.g., BRCA1/2, Lynch mutation). A positive family history indicative of germline mutations includes a brother, father, or multiple family members having been diagnosed with prostate cancer at age < 60 years, ≥ 3 cancers on the same side of family, especially diagnoses at age ≤ 50 years of bile duct, breast, colorectal, endometrial, gastric, kidney, melanoma, ovarian, pancreatic, prostate (but not clinically localized Grade Group 1), small bowel, or urothelial cancer. Ashkenazi Jewish ancestry is also a familial risk factor. Anyone who has intraductal histology should also undergo genetic testing.