New Genomic Test May Help Tailor Prostate Cancer Treatment
A study suggests the Decipher test could identify which men with high-risk prostate cancer benefit from aggressive hormone therapy.
Researchers at University College London (UCL) have analyzed a tissue-based molecular test called Decipher, suggesting it could help determine which men diagnosed with high-risk prostate cancer would benefit from intensified treatment, such as abiraterone hormone therapy, and which might avoid unnecessary medication and its side effects.
The findings were presented at the European Society for Medical Oncology (ESMO) Congress 2026 in Madrid.
The analysis focused on abiraterone, a hormone therapy that the STAMPEDE clinical trial previously showed could reduce the risk of death by half in men with high-risk, localized prostate cancer. However, not all prostate cancers are alike at the molecular level, and not all patients benefit from this type of hormone therapy.
To assess Decipher's utility, researchers examined data from over 27,000 patients and 401 men with non-metastatic prostate cancer who participated in the STAMPEDE abiraterone trial. According to the study, higher Decipher scores were linked to worse outcomes, indicating a higher likelihood of cancer spread and a potential benefit from additional treatment. Conversely, a low Decipher score suggested that more intensive treatment might not be necessary.
Dr. Sarah Howlett, lead researcher at the UCL Cancer Institute, stated that for men with very high-risk prostate cancer, preventing disease spread is critical. "Understanding who benefits most from additional treatment can make a meaningful difference," she said.
The study's results indicate that genomic testing could help personalize treatment. Men with high-risk prostate cancer and low Decipher scores might face a lower risk of spread and could potentially avoid more intensive therapies, while those with high scores may be better candidates for additional treatment. Howlett noted that the consistency of these findings across a large, real-world dataset and a randomized clinical trial strengthens the conclusions, though further validation is needed before routine clinical use.
Elai Davicioni, medical director of urology for Decipher test maker Veracyte, commented that the growing evidence supports physicians using Decipher before making treatment decisions that impact both cancer outcomes and patients' quality of life.
Dr. Marc Siegel, a medical analyst not involved in the study, noted that prostate cancer varies significantly among individuals, and medical science increasingly recognizes that a one-size-fits-all approach is insufficient. He explained that localized prostate cancer can harbor mutations that predict its aggressiveness and response to targeted therapies.
Siegel highlighted the study's strength in combining a randomized treatment group with Decipher testing to pre-identify patients most likely to respond to intensive hormone therapy, calling it "the personalized, precise approach of the near future."
Prostate cancer is the second-leading cause of cancer death in the United States, behind lung cancer. Approximately one in eight American men will be diagnosed with prostate cancer during their lifetime, according to the American Cancer Society.