HRR Mutation Testing Is Underutilized in Advanced Prostate Cancer

In an interview with

during the 2026 NCCN Annual Conference, Sandy Srinivas, MD, of Stanford Medicine, emphasized that biomarker testing, particularly for homologous recombination repair mutations, is essential but underutilized in advanced prostate cancer. Dr Srinivas stressed that despite the availability of approved targeted therapies, a significant number of patients with advanced disease are not being tested, representing a missed opportunity for precision treatment.

She advocated for moving testing earlier in the disease course, including in patients with hormone-sensitive disease. Identifying mutations such as BRCA opens the door to PARP inhibitor therapy. Dr Srinivas noted that niraparib (Zejula) is approved in combination with androgen deprivation therapy and abiraterone (Xytiga) for these patients. Additionally, she highlighted emerging data, citing a recent press release showing that the PARP inhibitor talazoparib (Talzenna), when combined with enzalutamide (Xtandi), also demonstrates clinical benefit.

The overarching message is clear: testing must become a routine part of management. Early and comprehensive mutation testing allows clinicians to identify patients who are most likely to benefit from targeted combinations, potentially improving outcomes. Dr Srinivas concludes that leveraging these biomarkers is critical to delivering personalized care and ensuring that patients receive therapies aligned with their tumor biology.