New test could flag which men need aggressive prostate cancer treatment and which don’t
Researchers at University College London say the Decipher genomic test may help identify men with high-risk, localised prostate cancer who are most likely to benefit from adding abiraterone, and those who may avoid its side effects. The findings could support more tailored treatment, but researchers say further validation is needed before the test guides routine decisions.
The analysis included test scores from more than 27,000 patients in real-world data and 401 men in the STAMPEDE trial. Higher Decipher scores were linked to worse outcomes and may indicate greater benefit from additional treatment; lower scores suggested intensive therapy may be unnecessary. Abiraterone previously halved the risk of death in men with high-risk, localised disease in the trial.
In short
- Decipher scores may help tailor prostate cancer treatment.
- High scores were linked to worse outcomes.
- More research is needed before routine use.
Steelman: both sides, in good faith
The strongest fair case each way — we don't pick a winner.
The case for
Using the Decipher test could help match treatment to the men most likely to benefit: those with high-risk scores may gain from adding abiraterone, while those with lower scores could avoid side effects from intensive therapy. More tailored decisions may improve the balance between survival benefit and treatment burden, while further validation can strengthen confidence in the test.
The case against
The evidence does not yet establish that Decipher scores reliably identify who benefits enough to change routine treatment decisions. The trial analysis involved 401 men, and acting too soon on an unvalidated test could lead some patients to miss a treatment that has been shown to reduce the risk of death; decisions should continue to weigh established evidence and individual circumstances.
Explained simply
Prostate cancer is cancer that starts in the prostate, a small gland below the bladder. When it is localised, it has not spread to distant parts of the body, but some cases are more likely than others to grow or return.
Doctors use factors such as test results and scans to judge how likely the cancer is to cause harm and to choose treatment. Abiraterone is a medicine that reduces male hormones that can help prostate cancer grow; adding it to other treatment can bring side effects.
Decipher analyses features of a tumour’s genes and gives it a score linked to how aggressive it may be. Researchers are studying whether that score can help distinguish men who may benefit from extra treatment from those for whom its harms may outweigh the benefit.
Health Medicine Mental Health World