Genomic Test May Spare Prostate Cancer Patients From Unnecessary Hormone Therapy

A Smarter Way to Treat Prostate Cancer

For decades, the approach to treating high-risk prostate cancer has followed a blunt logic: if an aggressive therapy helps some patients, offer it to all of them. Now, a genomic test may finally give doctors the precision tool they've long needed to tell those patients apart. Veracyte's Decipher tissue-based molecular test can help identify which patients with high-risk, localized prostate cancer will benefit from adding the hormonal therapy abiraterone to their standard care, according to findings from researchers at University College London.

Because prostate cancers vary at the molecular level, adding hormone therapy indiscriminately risks increased side effects and a poorer quality of life for patients who do not require it. That's the core problem this research is trying to solve — not just keeping people alive, but making sure the treatment itself doesn't become its own burden.

How the Decipher Test Works

The Decipher test, developed by diagnostics company Veracyte, utilizes tissue samples already extracted during routine diagnostic biopsies or prostate surgeries, meaning patients do not need to undergo additional invasive procedures to receive a personalized risk score. That's a significant practical advantage. By measuring the expression of 22 specific genes associated with tumor aggression and cellular proliferation, the algorithm generates a score between zero and one, where a higher score indicates a significantly elevated probability that the cancer will metastasize to distant organs or recur following initial localized treatments.

According to the research team led by Dr. Sarah Howlett at University College London, each 0.1 increase in the Decipher score correlates with a 49 percent higher risk of the cancer spreading and a 38 percent higher risk of mortality from the disease. This granular data allows oncologists to move beyond broad clinical staging and base their treatment recommendations on the specific molecular behavior of the individual tumor.

What the Data Revealed

Researchers analyzed the test's ability to predict outcomes for patients considering abiraterone — a hormone therapy that the STAMPEDE clinical trial showed cuts the risk of death in half for men with high-risk, localized prostate cancer. The findings were presented at the European Society for Medical Oncology Congress 2026 in Madrid, held October 23–27. The UCL team examined Decipher scores from two datasets: real-world data from 27,607 men and 401 men randomized within the STAMPEDE abiraterone trial.

The STAMPEDE data reveals that men with high-risk clinical features but a low Decipher score exhibit low rates of metastasis and can potentially be spared the intensive hormone blockade. Conversely, men with high genomic scores derive a profound survival advantage from the addition of abiraterone, justifying the acceptance of its adverse effects. Critically, the Decipher score predicted which men whose cancer had not spread to the lymph nodes gained a protective benefit from abiraterone in halting metastatic spread.

What Comes Next

Elai Davicioni, medical director of urology for Veracyte, said the growing evidence gives physicians "a stronger reason to use Decipher before making decisions that can affect both cancer outcomes and patients' quality of life," and that the findings expand the test's predictive evidence to another consequential treatment decision.

While the retrospective analysis of the STAMPEDE cohort provides compelling evidence, researchers caution that prospective, randomized trials are still required before the Decipher test can be universally mandated as the sole determinant for abiraterone prescription. Another trial prospectively evaluating the use of the Decipher test to guide treatment intensification or de-intensification in high-risk prostate cancer — the phase III NRG-GU009 (PREDICT-RT) study — completed enrollment earlier this year and will add further predictive evidence around the test. The science is moving fast, and for the roughly 64,000 men diagnosed with prostate cancer in the UK each year alone, a test that can finally match treatment to the tumor — not just the diagnosis — could change everything.