Decipher Prostate Test Predicts Who Benefits From Short-Term ADT in Intermediate-Risk Prostate Cancer
核心洞察
A retrospective ancillary analysis of the phase III NRG/RTOG 0815 trial found the Decipher Prostate Genomic Classifier (搜索) predicts benefit from adding short-term androgen deprivation therapy (搜索) to dose-escalated radiation.
The treatment-by-Decipher interaction for distant metastasis was statistically significant at p<0.001, providing Level 1B1 prognostic and predictive evidence in intermediate-risk disease.
Patients with intermediate or high Decipher scores gained an 8% absolute reduction in 10-year distant metastasis, while the 44% with low scores saw a non-significant 1 percentage point difference.
Veracyte reported that a retrospective ancillary analysis of the randomized phase III NRG/RTOG 0815 trial shows its Decipher Prostate Genomic Classifier (搜索) can identify which men with intermediate-risk prostate cancer (搜索) are more likely to benefit from adding short-term androgen deprivation therapy (搜索) (ADT) to dose-escalated radiation. The findings, presented at the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting in Boston, provide what the company describes as both Level 1B1 prognostic and predictive evidence for the test.
The results were delivered in an oral session by Angela Jia, M.D., Ph.D., of University Hospitals Seidman Cancer Center and Case Western Reserve University. The abstract, "Genomic Stratification of Benefit from Short-Term Androgen Deprivation with Dose-Escalated Radiotherapy in Intermediate-Risk Prostate Cancer (搜索): An Ancillary Study of NRG/RTOG 0815," was presented on Tuesday, September 29, 2026, in the session "Predicting Benefit and Toxicity: Biomarkers in Prostate Radiotherapy."
Differential Benefit by Genomic Score
The analysis found a statistically significant treatment-by-Decipher interaction for distant metastasis (p<0.001), indicating that the magnitude of ADT benefit varies with tumor biology. Among patients with intermediate or high Decipher scores, adding short-term ADT was associated with an 8% absolute reduction in distant metastasis at 10 years. Among the 44% of patients with low Decipher scores, the absolute difference in 10-year distant metastasis was 1 percentage point and was not statistically significant.
"For men with intermediate-risk prostate cancer (搜索), the question is not simply whether hormone therapy works, it is who truly needs it," Jia said. "This analysis suggests tumor biology can distinguish patients who may achieve a substantial reduction in the risk of distant metastasis from those who may see little added benefit. That could help clinicians and patients make a more individualized decision about intensifying treatment."
The Decipher score was also independently associated with greater risk of biochemical failure, distant metastasis and prostate-specific mortality, confirming its prognostic role alongside its predictive signal for ADT benefit across both distant metastasis and prostate cancer-specific mortality endpoints.
Trial Design and Biomarker Cohort
NRG/RTOG 0815 was a randomized phase III trial evaluating the addition of short-term ADT to dose-escalated radiation in patients with intermediate-risk prostate cancer (搜索). In the NCI-approved ancillary analysis, archived diagnostic biopsy specimens were evaluated using the locked, clinical-grade 22-gene Decipher Genomic Classifier (搜索). The biomarker cohort comprised 395 patients with a median follow-up of 10.2 years and was representative of the overall trial enrollment of 1,492 patients, balanced between treatment arms. The primary endpoint was distant metastasis; secondary endpoints included biochemical failure, metastasis-free survival, prostate cancer-specific mortality and overall survival.
The clinical rationale for the analysis rests on the biological heterogeneity of intermediate-risk disease. While ADT can reduce the risk of recurrence and distant spread, it carries metabolic and quality-of-life effects. According to the investigators, clinical variables such as Gleason grade, PSA or clinical stage may not reveal which patients are most likely to benefit from adding the therapy.
"For men with intermediate-risk prostate cancer (搜索), these findings provide predictive evidence that treatment decisions can be guided by the biology of each patient's tumor, not simply a broad clinical risk category," said Daniel E. Spratt, M.D., chair of the Department of Radiation Oncology at University Hospitals Cleveland Medical Center, professor at Case Western Reserve University School of Medicine, and a study author. "Decipher may help identify who is likely to gain meaningful protection from metastasis by adding hormone therapy and who may face its health and quality-of-life effects with little added benefit."
From Prognosis to Treatment Selection
Elai Davicioni, Ph.D., Veracyte's medical director for Urology, framed the analysis as an extension of the test's established role in risk assessment. "These findings provide the first evidence that Decipher can predict which men with intermediate-risk prostate cancer (搜索) are most likely to benefit from adding hormone therapy to radiation," he said. "This extends the Decipher test's prognostic use toward answering a more consequential question: Will this treatment make a meaningful difference for this patient?"
Davicioni added that the company believes all men diagnosed with intermediate-risk prostate cancer (搜索) may benefit from use of Decipher in their care pathway.
Prospective Validation Underway
A separate phase III biomarker-driven study, NRG-GU010 (GUIDANCE), is prospectively evaluating the Decipher prostate test to guide treatment intensification or de-intensification. The trial completed enrollment earlier this year and is designed to build on the NRG/RTOG 0815 findings, further expanding the predictive evidence for the test in intermediate-risk disease.
Veracyte's portfolio includes the Afirma Genomic Sequencing Classifier test, the Decipher Bladder Genomic Classifier test, the Decipher Prostate Genomic Classifier (搜索) test, the Prosigna Breast Risk of Recurrence test, and the TrueMRD Monitoring Test for MIBC.