New Genetic Test Could Halve Risk of Death for High-Risk Prostate Cancer Patients

A new genetic test is poised to significantly improve outcomes for men with high-risk prostate cancer by identifying those who will benefit most from aggressive treatment, potentially cutting their risk of death in half. Prostate cancer is the most common cancer affecting men, with approximately 64,000 new diagnoses annually in the UK alone.

Doctors currently face challenges in balancing the need for aggressive treatment against the risk of debilitating side effects for patients who may not significantly benefit. Research indicates that adding abiraterone, a hormone therapy that blocks testosterone production, to standard treatment could halve the risk of dying from the disease. This therapy was recently introduced to the NHS in England, following its adoption in Wales and Scotland.

However, a lack of reliable methods to predict which patients will gain the most from abiraterone means some may endure side effects like fatigue, liver damage, and urinary tract infections without substantial benefit.

Experts at University College London (UCL) have developed a test that analyzes tumor tissue, already obtained through biopsies or surgery, to help pinpoint patients most likely to respond to abiraterone. "Abiraterone saves lives but we may currently be over-treating some patients with this therapy," said Dr. Sarah Howlett, the study's lead author. "With this test, we can identify which patients need the treatment most and avoid it for those who don't, giving doctors more of an idea of which patients are at the highest risk of their cancer returning."

The Decipher test, analyzed in the STAMPEDE trial and presented at the European Society for Medical Oncology Congress in Madrid, examined data from over 30,000 men. It assesses the activity of 22 genes within tumor tissue to gauge the aggressiveness of a patient's cancer. Patients receive a score between 0 and 1, with higher scores indicating a greater risk of the cancer spreading or recurring.

Researchers found that each 0.1 increase in the Decipher score correlated with a 49% higher risk of cancer spreading to distant organs and a 38% higher risk of death from prostate cancer. The findings suggest that the test can help doctors target intensive treatments more effectively toward those who need them most, while sparing others unnecessary side effects.

"For men with very high-risk prostate cancer, preventing the cancer from spreading is critical, and understanding who benefits most from additional treatment can make a meaningful difference," Dr. Howlett stated. "Our findings suggest that a genomic test could help personalize treatment: men with high-risk disease but a low Decipher score have low rates of cancer spread and could potentially be spared more intensive treatment, while men with a high score could be prioritized for it."

While the results are promising, Dr. Howlett cautioned that larger studies are required before the test can be routinely used to guide treatment decisions. Elai Davicioni, medical director at Veracyte, the company that produces the Decipher test, expressed optimism, stating, "We believe this growing evidence gives physicians a stronger reason to use Decipher before making decisions that can affect both cancer outcomes and patients’ quality of life."