Genetic Test Helps Predict PCa Progression on Active Surveillance

M. Alexander Otto, MMS, PA

December 03, 2021

Key Takeaways

  • The Decipher Prostate genomic classifier — a genomic test performed on biopsy samples to gauge the expression of 22 genes involved in prostate cancer progression — was associated with Gleason upgrading among men on active surveillance for low- or favorable-intermediate-risk prostate cancer.

  • Integration of the Decipher score improved the predictive power of baseline clinical features, although only modestly.

Why This Matters

  • There is an unmet need to better identify patients with prostate cancer who will progress on active surveillance.

  • Incorporating Decipher testing into standard clinical predictors might help guide decision-making surrounding active surveillance as well as the intensity of monitoring.

  • Decipher has been validated as a predictor of PCa recurrence, metastasis, and mortality, but there has been little evidence until now for its value in active surveillance.

Study Design

  • The study was a review of 133 men with prostate cancer under active surveillance. Decipher testing was performed on their baseline biopsy samples.

  • The goal was to examine the association between the baseline Decipher score and Gleason upgrading on subsequent biopsies.

Key Results

  • Forty-three patients (32%) had a biopsy upgrade.

  • Decipher scores were significantly associated with biopsy upgrade (OR, 1.37 per 0.10 unit increase; P = .02).

  • Decipher scores above a cutoff of 0.475 increased the odds of biopsy upgrade nearly fourfold (OR, 3.71; P = 0.01).

  • Scores were associated with upgrade for Grade Group 1 disease (OR, 1.29 per 0.10 unit; P = .047) but not Grade Group 2 disease (P = .41).

  • The discriminative ability of clinical predictors of progression increased with the integration of Decipher scores.


  • Patients at higher risk of progression may have been more likely to be tested.

  • Sample size and follow-up were insufficient to assess long-term outcomes.


Funding source and investigator disclosures were not reported.

This is a summary of a preprint research report led by Benjamin Press of Yale University in New Haven, Conn., provided to you by Medscape. The study has not yet been peer-reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science, and an award-winning medical journalist who has worked for several major news outlets before joining Medscape. He is an MIT Knight Science Journalism fellow. Email:

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