Genomic Tissue Test Predicts Metastasis and Abiraterone Benefit in High-Risk Prostate Cancer

Prostate cancer is the most common cancer in men, affecting more than 1 million men worldwide in 2013. Its clinical course varies substantially between patients, complicating efforts to identify those who need intensified treatment and those who may avoid additional toxicity. To help guide these decisions, new findings suggest that a tissue-based molecular test may refine treatment selection in men with high-risk disease.

University College London (UCL, London, UK) researchers evaluated Veracyte’s (South San Francisco, CA, USA) Decipher tissue-based molecular test in men with non-metastatic prostate cancer, assessing whether its molecular score could predict outcomes and treatment benefit. Specifically, the analysis examined whether Decipher could identify which patients would benefit most from adding the hormone therapy abiraterone to standard treatment.

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The UCL team examined Decipher scores from two datasets: real-world data from 27,607 men, including 5,956 analyzed for outcomes, and 401 men randomized within the STAMPEDE abiraterone trial. Findings from STAMPEDE, presented at a major cancer conference in Madrid, showed that adding abiraterone to standard treatment for high-risk, localized prostate cancer could halve the risk of death from the disease and slow overall progression.

Across the analysis, higher Decipher scores consistently predicted worse outcomes. For every 0.1 increase in score, the adjusted hazard ratio for distant metastasis was 1.49, while the hazard ratio for prostate cancer death was 1.38. Beyond predicting prognosis, the score also identified which patients without lymph node involvement would benefit from abiraterone in preventing distant spread.

The work involved UCL Cancer Institute and Veracyte, with the findings presented in the context of treatment decisions for very high-risk prostate cancer. The researchers emphasized that further validation in other datasets is needed before the test is used routinely to guide these decisions.

“For men with very high-risk prostate cancer, preventing the cancer from spreading is critical, and understanding who benefits most from additional treatment can make a meaningful difference. Our findings suggest that a genomic test could help personalize treatment: men with high-risk disease but a low Decipher score have low rates of cancer spread and could potentially be spared more intensive treatment, while men with a high score could be prioritized for it,” said Dr. Sarah Howlett, lead researcher at UCL Cancer Institute.

“Showing the same pattern in both a large real-world dataset and a randomized clinical trial strengthens the findings. But further validation in other datasets is needed before the test is used routinely to make these decisions,” added Dr. Howlett.

Related Links
UCL Cancer Institute
Veracyte