Background: Germline testing (GT) for prostate cancer (PCa) helps to determine treatment selection and other cancer risk, which guides screening recommendations. Patients with PCa that is high risk group by NCCN and greater stage should receive genetic counseling (GC) referral. There is limited data on differences in genetic services given the rurality of PCa patients. This study aims to determine the geographical distribution of PCa patients meeting GC referral and GT criteria. Methods: A retrospective analysis evaluated data from electronic medical records of PCa patients at an NCI-designated cancer research facility. Data was abstracted from new PCa patients seen in 2019 and 2021, years before and after the COVID-19 pandemic. Data includes demographic information, cancer staging, and pathology results. Regions of urbanicity, urban and non-urban (rural/frontier), were categorized through zip codes and defined by Utah Department of Health and Human Services. Criteria for GT followed NCCN guidelines (v.1.2023). Statistical methods for descriptive and comparative analysis done using Chisquare, Fisher’s exact, and Mann Whitney tests in R*Stats to compare 2019 and 2021 cohorts. Results: Out of 525 PCa patients' initial treatment at HCI in 2019 (n = 346) and 2021, (n = 179) 94% self-reported as White (p = 0.164) with a median age of 66 (p = 0.690) and 51% being employed (p = 0.396) at time of first treatment. Of these, 414 (79%) were from an urban area and 111 (21%) from a non-urban area (p = 0.883). The cohort was primarily from 2019 (66%), with 274 (79%) and 72 (21%) of the PCa patients living in urban and non-urban areas, respectively. In 2021 (34%), 140 (78%) and 39 (35%) patients were from urban and non-urban areas. Criteria for GT were met in 37% (n = 196) of PCa patients (p = 0.595). Regions were independently compared by race, age, employment, and year. No statistical difference across all variables was found (p > 0.05). Geographical regions did not impact GT eligibility. Conclusions: This preliminary study shows that geographical region does not impact GT eligibility in PCa patients seen at HCI during 2019 and 2021. The years analyzed is a proxy for differences in aggressiveness by rurality. The results show 37% of the PCa patients met criteria for GT. No significant differences were identified by geographical region, race, age, employment, or the year of initial treatment. Further research is being conducted to determine if access to PCa GC uptake is impacted by geography and differing service delivery models after criteria for GT has been met.