Decipher testing may enhance risk stratification in active surveillance for prostate cancer

Findings from a recent study suggest that incorporating Decipher genomic classifier (GC) scores with Gleason grade group may improve risk stratification for patients with biopsy grade group 1 (GG1) or grade group 2 (GG2) prostate cancer who are on active surveillance (AS).¹

Specifically, data showed that patients with GG1 disease and a high genomic classifier score had a significantly higher risk of disease progression.

“Overall, Decipher genomic classifier stratified patients’ risk of progression. Clinically, this allows for less intensive follow-up for men with low- and intermediate-risk genomic classifier [scores] while those with a high-risk genomic classifier score would benefit from closer surveillance,” explained co-author Preston C. Sprenkle, MD, of Yale Medicine, New Haven, Connecticut, in correspondence with Urology Times®. “[However,] I would still recommend surveillance [for these high-risk patients] as only 30% of men progressed within 5 years.”

In total, the retrospective study included 224 patients with GG1 or GG2 prostate cancer who had undergone Decipher genomic testing and had a minimum of 2 biopsies. Among all participants, 19 (8.5%) had GG1 and a low genomic classifier score, 54 (24.1%) had GG1 and an intermediate genomic classifier score, 51 (22.8%) had GG1 and a high genomic classifier score, and 100 (44.6%) had GG2 and a low genomic classifier score.

Overall, 114 patients (50.9%) progressed to treatment over the 5-year follow-up period. Across the risk groups, the progression rates were 10.5% in the GG1/low GC group, 13% in the GG1/intermediate GC group, 29.4% in the GG1/high GC group, and 90% in the GG2/low GC group.

Using Fine & Gray regression analysis, the investigators found that patients with GG1/intermediate genomic classifier scores demonstrated similar outcomes to patients with GG1/low genomic classifier scores (SHR 0.84; P = .83). According to the authors, the similar behavior between these 2 risk groups is expected in active surveillance.

However, data showed that patients with GG1/high genomic classifier scores demonstrated a significantly higher risk of progression (SHR, 5.12; P = .036), as well as patients with GG2/low genomic classifier scores (SHR, 12.38; P = .001) compared with GG1/GC even after adjustment for PIRADS 4-5 (SHR 1.36; P = .112) and prostate-specific antigen density (PSAD) (SHR, 13.0; P = .009).

Further, data showed that elevated PSAD at baseline was independently associated with higher progression risk. According to the authors, this finding “emphasiz[es] PSAD use in AS risk assessment as a potential biomarker.”

Based on the findings from the study, the authors concluded, “These results suggest higher [genomic classifier] category with GG1 as well as GG2 low [genomic classifier score] may warrant earlier definitive treatment or cautious surveillance. The incorporation of Decipher [genomic classifier] with Gleason grade group serves to improve risk stratification of the AS prostate cancer cohort and provides promise to guide personalized management for the AS cohort.”

REFERENCE
1. Zhang A, Sivanesan N, Barreto A, Sprenkle PC. Stratifying risk in active surveillance for prostate cancer using Decipher genomic classifiers and Gleason grade group. Presented at: Society of Urologic Oncology Annual Meeting; December 2-5, 2025; Phoenix, Arizona. Abstract 244. https://suo-abstracts.secure-platform.com/a/gallery/rounds/24/details/4651