Diagnostic test could help doctors refine prostate cancer treatment

Prostate cancer is the most common cancer among men, affecting over 1 million globally in 2013. Doctors struggle to determine the appropriate level of treatment, as over-treating can lead to severe side effects and a reduced quality of life. At a cancer conference in Madrid, University College London researchers presented new findings from their STAMPEDE clinical trial, which demonstrated that adding the hormone therapy abiraterone to standard treatment could halve the risk of death and slow the disease's progression for men with high-risk, localized prostate cancer.

However, other trials have not always shown this benefit. To identify which patients might benefit most from more aggressive treatment, researchers explored using the Decipher tissue-based molecular test. This test analyzes genomic data to predict outcomes. The UCL team analyzed Decipher scores from a large real-world dataset of 27,607 men and the 401 men who participated in the STAMPEDE trial.

They found that higher Decipher scores consistently predicted worse outcomes, with a 0.1 increase in the score associated with a 49% higher risk of distant metastasis and a 38% higher risk of dying from prostate cancer. The test could help identify men with high-risk disease but low Decipher scores who might avoid more intensive treatment, while those with high scores could be prioritized for it.

This approach could personalize treatment and improve outcomes while minimizing side effects. The findings were consistent in both large real-world data and a randomized clinical trial, strengthening the evidence. However, further validation in other datasets is needed before widespread adoption. In January, NHS England announced plans to roll out abiraterone for high-risk, locally advanced prostate cancer patients in England, with similar access in Wales and Scotland.

Elai Davicioni, medical director at Veracyte, the company that makes the Decipher test, noted that growing evidence should encourage physicians to use Decipher to make more informed decisions about treatment intensity and patient outcomes.