Background: Germline genetic testing criteria for individuals with prostate cancer (PCa) are expanding. Alternative genetic service models are needed to meet increased need for genetic testing. Studies have shown no difference in genetic testing uptake, satisfaction, or knowledge when patients undergo face-to-face genetic counseling compared to pre-test video genetic education (VGE). Data is limited comparing options for how video genetic education is delivered. This study evaluated the impact of pre-test VGE when facilitated by a genetic counseling assistant (assistant-led) or self-completed by the patient (patient-led). Methods: Individuals with PCa referred for genetic counseling received pre-test VGE. Patients were randomized so that this process involved meeting with a genetic counseling assistant or completed at the patient’s convenience via email instructions. Pre-test VGE included family history completion via electronic software and viewing of informational video. VGE completion and genetic testing uptake were measured for all participants. Questionnaires regarding satisfaction, and knowledge were optional for participants after VGE completion. Data was analyzed using t-test and Fisher’s exact. Results: Eighty-one individuals referred for genetic counseling from October 2020-March 2021, and 78 individuals were randomized (1:1) to assistant-led or patient-led VGE, with 39 individuals in each arm. After removing patients for technological limitations, loss to follow up, and procedural withdrawals, there were 18 patients in the assistant-led arm, and 16 patients in the patient-led arm. The primary reason for discontinuing the process was lack of response to phone and electronic contacts to schedule their genetics visit (n = 22). The median age was 64.5 years, with no difference between the two arms (p = 0.698). Participants identified primarily as white/Caucasian (n = 32, 94%). In the assistant-led group, all participants elected to undergo germline genetic testing and 13 (81%) opted for genetic testing in the patient-led group. There was no difference in genetic testing uptake between the two arms (p = 0.094). Nine patients in the patient-led group and eight patients in the assistant-led group completed the questionnaires. There was no difference in satisfaction with their VGE experience (p = 0.815) or knowledge using the KnowGene scale (p = 0.120). Conclusions: Preliminary data suggests there is no difference in genetic testing uptake when pre-test VGE is facilitated by a genetic counseling assistant or self-led by the patient. Given no preliminary differences in satisfaction and knowledge, patient-led pre-test VGE may serve as a viable option prior to germline testing in PCa patients. Additional research is needed with larger sample size. Furthermore, evaluation of the facilitators and barriers of VGE is needed as there was significant drop off in completion of video pre-test VGE.