Genomic Classifiers Improve Risk Stratification and Treatment Selection in Urologic Cancers

Prostate and bladder cancers show significant biological heterogeneity, complicating risk stratification and treatment selection. Clinicians are increasingly incorporating genomic classifiers alongside clinicopathologic factors to support more individualized care. New data presented at a major urology meeting highlight how molecular profiling and real-world evidence can refine decision-making, showcasing a genomic classifier portfolio that supports risk assessment and guides therapy selection across urologic cancers.

Veracyte’s (San Francisco, CA, USA) Decipher portfolio is the subject of more than 15 studies accepted for presentation at the American Urological Association (AUA) 2026 Annual Meeting, taking place May 15–18 in Washington, D.C. The work showcases clinical utility for Decipher Bladder molecular subtyping and expanding real‑world evidence for Decipher Prostate in practice. Analyses also leverage the Decipher Genomics Research for Intelligent Discovery (GRID) research tool to link genomic signals with clinical outcomes across diverse populations.

The Decipher Prostate Genomic Classifier is a 22‑gene assay developed using RNA whole‑transcriptome analysis and machine learning. Performed on biopsy or surgically resected tissue, it provides an assessment of the risk of developing metastasis with standard treatment to inform therapeutic intensity. The Decipher Bladder Genomic Classifier is a 219‑gene assay, likewise built on RNA whole‑transcriptome analysis and machine learning, that classifies tumors into five molecular subtypes with distinct tumor biology to help address questions around neoadjuvant chemotherapy benefit and the likelihood of non‑organ‑confined disease at surgery. The GRID database includes more than 200,000 whole‑transcriptome profiles and is made available for research use.

Several presentations at AUA 2026 highlight the clinical relevance of molecular subtyping in bladder cancer using the Decipher Bladder test, including its role in guiding treatment decisions and predicting outcomes. Key studies include a poster on treatment de-escalation for luminal-favorable muscle-invasive disease, biomarker analyses of non-luminal subtypes in the setting of neoadjuvant chemo-immunotherapy, and work linking non-luminal status with overall survival in high-risk non–muscle-invasive disease. Additional podium research examines transforming growth factor-beta (TGF-β) activity, fibroblast infiltration, and immune exclusion in muscle-invasive bladder cancer. Collectively, these findings show how molecular subtyping can refine risk assessment, distinguish outcomes across subgroups, and deepen understanding of tumor biology.

Real-world prostate cancer analyses presented at AUA 2026 include a national clinical–genomic linkage study evaluating how biopsy-based classifier results correlate with initial treatment selection, as well as a cohort analysis assessing genomic classifier results and the use of post-prostatectomy therapy. Another study examines expression of PET targets, prostate-specific membrane antigen (PSMA) and acid phosphatase 3 (ACP3), in a large radical prostatectomy cohort from the GRID registry. Together, these efforts illustrate how integrated genomic and clinical datasets can inform contemporary management patterns and ongoing research.

“These studies underscore the power of Veracyte’s Diagnostics Platform to generate clinically meaningful evidence at scale,” said Elai Davicioni, Ph.D., Veracyte’s medical director, Urology. “With more than a decade of data in our Decipher GRID tool, we are accelerating research to drive new discoveries that help clinicians better personalize care and improve outcomes for patients.”

“These data suggest that molecular subtyping using Decipher Bladder may help identify patients who are more likely to achieve downstaging and complete responses to neoadjuvant chemo-immunotherapy,” said Shilpa Gupta, M.D., GU Oncologist, Cleveland Clinic. “By better understanding tumor biology upfront, we have the potential to more precisely select therapies and, ultimately, improve outcomes while avoiding unnecessary treatment for patients with muscle-invasive bladder cancer.”

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