Introduction: Providers use prostate specific antigen testing, exam findings, and biopsy grade to risk stratify newly diagnosed prostate cancer. Tissue-based genomic testing for localized disease can further refine risk stratification to determine candidacy for active surveillance and local therapies. However, these tests are costly, making them at risk for uneven early adoption. We analyzed the trend of early adoption of tissue-based genomic testing among newly diagnosed prostate cancer patients and evaluated factors associated with their utilization. Methods: We used billing claims from MarketScan® (2017–2020) database to identify patients with newly diagnosed prostate cancer. We excluded those with advanced prostate cancer and without continuous enrollment for 3 months prior to/after their diagnosis date. The primary outcome was receipt of tissue-based genomic tests (Prolaris®, OncotypeDx®, and Decipher®). Covariates of interest included insurance provider, year of diagnosis, patient factors, and geographic location. Multivariable logistic regression was used to assess association between receipt of genomic testing and covariates of interest. We then assessed geographic variation in use of genomic testing among the ten highest-volume U.S. metropolitan areas. Results: We included 30,910 men with newly diagnosed localized prostate cancer. Among this cohort, 1673 (5.4 %) patient received genomic testing. Between 2017 and 2020, there was an increase in the receipt of genomic testing (2.3% 2017 vs. 10.2% 2020, adjusted OR 4.75, 95% 4.01 – 5.64). Compared to those over 74 years of age, younger patients were more likely to have genomic testing (5.8% <55 years vs 3.8% 75+, adjusted OR 2.64, 95% CI 1.15 – 6.07). Compared to those with health maintenance organization health plans, patients with high-deductible health plans were more likely to have genomic testing (5.0% HMO vs 7.3% HDHP, adjusted OR 1.66, 95% 1.39 – 1.99). Among the ten highest volume metropolitan areas, use of genomic testing ranged from 2.3% in the New York City suburbs to 14.1% in the Detroit suburbs. Conclusions: The utilization of tissue-based genomic testing increased rapidly after 2017 among newly diagnosed prostate cancer patients with commercial or Medicare supplemental insurance. There was wide variation across metropolitan regions, suggesting local coverage decision and provider factors may carry influence over use of these tests. Future studies should evaluate the impact of provider factors and the economic implications of incorporating these tests for risk-stratification. SOURCE OF Funding: Winship Cancer Institute Pilot Grant
