Decipher may help identify ADT benefit in intermediate-risk prostate cancer

In this video, Angela Jia, MD, PhD, discusses an ancillary analysis of NRG/RTOG 0815 evaluating whether the 22-gene Decipher genomic classifier can identify patients with intermediate-risk prostate cancer who may derive greater benefit from short-term androgen deprivation therapy (STAD) added to dose-escalated radiotherapy. These findings were presented at the 2026 American Society for Radiation Oncology Annual Meeting in Boston, Massachusetts.¹

Jia is a radiation oncologist at University Hospitals Seidman Cancer Center in Cleveland, Ohio.

NRG/RTOG 0815 previously showed that adding 6 months of STAD to dose-escalated radiotherapy did not improve overall survival, although it reduced biochemical failure, the need for salvage ADT, and distant metastases.² In an ancillary analysis of the trial, investigators evaluated Decipher scores from archived biopsy specimens to determine whether the genomic classifier could both stratify baseline risk and identify differences in treatment benefit. Among 395 patients with tissue that passed quality control, median follow-up was 10.2 years.

Higher Decipher scores were independently associated with greater risks of biochemical failure (sHR, 2.19; 95% CI, 1.36 to 3.53; P < .001) and distant metastasis (sHR, 4.89; 95% CI, 0.98 to 24.3; P = .05) .

The analysis also identified a significant interaction between Decipher score and STAD for distant metastasis and prostate cancer–specific mortality (both p-interaction < .001). Patients with low Decipher scores (<0.45) had a 1% 10-year risk of distant metastasis with radiotherapy alone, with only a 1% absolute reduction with the addition of STAD. In contrast, patients with intermediate or high scores had a 10% 10-year risk of distant metastasis with radiotherapy alone, compared with 2% when STAD was added, representing an 8% absolute difference. Jia explains that these findings illustrate the potential role of a predictive biomarker in distinguishing patients who may derive greater benefit from treatment intensification.

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REFERENCES

1. Jia AY, Johnson M, Proudfoot J, et al. Genomic Stratification of Benefit from Short-Term Androgen Deprivation with Dose-Escalated Radiotherapy in Intermediate-Risk Prostate Cancer: An Ancillary Study of NRG/RTOG 0815. Presented at: 2026 American Society for Radiation Oncology Annual Meeting. September 26 -30, 2026. Boston, Massachusetts. Abstract 312

2. Krauss DJ, Karrison T, Martinez AA, et al. Dose-Escalated Radiotherapy Alone or in Combination With Short-Term Androgen Deprivation for Intermediate-Risk Prostate Cancer: Results of a Phase III Multi-Institutional Trial. J Clin Oncol. 2023;41(17):3203-3216. doi:10.1200/JCO.22.02390