Prostate cancer presents a challenge due to its heterogeneity; some tumors are slow-growing (indolent), while others are aggressive and require intensive treatment. Traditional risk assessment tools, such as Prostate-Specific Antigen (PSA) levels, Gleason score, and clinical stage, often fail to reliably distinguish between these types. This uncertainty forces difficult choices between unnecessary, life-altering treatments and the risk of undertreating a dangerous tumor. A more sophisticated method is needed to assess the true biological nature of the cancer.
What is Genomic Risk Stratification?
Genomic risk stratification analyzes the tumor’s underlying biology by examining the genetic material within cancer cells to determine their potential for aggressive behavior. The goal is to accurately predict how the disease will progress over time.
This method uses a genomic classifier, which evaluates the activity, or expression, of a specific set of genes within the tumor sample. By measuring which genes are turned “on” or “off,” the classifier creates a molecular profile of the cancer. This profile provides prognostic information that is independent of traditional clinical factors like Gleason grade or PSA level, helping refine a patient’s risk category.
How Decipher Prostate Analyzes Tumor Samples
The Decipher Prostate Test provides a detailed molecular analysis by examining the ribonucleic acid (RNA) within the tumor tissue. The test can be performed on prostate tissue collected during a biopsy or after surgical removal, requiring no additional medical procedure.
The core of the test quantifies the expression of 22 specific RNA markers involved in prostate cancer progression and metastasis. This analysis uses whole-transcriptome sequencing and machine learning algorithms. These computational methods translate the complex pattern of gene activity into a single, comprehensive score, which measures the tumor’s intrinsic aggressiveness.
Understanding Your Decipher Risk Score
The Decipher Prostate Test generates a continuous genomic risk score ranging from 0 to 1.0, where a lower number indicates less aggressive tumor biology and metastatic potential. This continuous score is translated into three distinct risk categories for clinical interpretation: Low, Intermediate, and High.
A low Decipher score (typically below 0.45) correlates with a low probability of the cancer spreading. For these patients, the estimated risk of metastasis within five years is generally around five percent.
Conversely, a high score (often above 0.60) signifies a significantly more aggressive cancer and predicts a greater risk of adverse outcomes. High-risk patients face a substantially elevated risk of disease progression, with some studies showing a five-year metastasis risk exceeding 23 percent. The score also provides projections for prostate cancer-specific mortality.
The Intermediate category (between 0.45 and 0.60) indicates a moderate risk, with an approximate 9.3 percent chance of metastasis at five years. This helps distinguish which intermediate-risk patients lean toward a more aggressive or more indolent course.
How the Test Informs Treatment Planning
The genomic risk score provides direct, actionable insights that help personalize the patient’s treatment pathway. For men with newly diagnosed, low- or favorable intermediate-risk disease, the test is useful in deciding between active surveillance and definitive intervention. A low Decipher score offers the confidence needed to safely choose active surveillance, avoiding the side effects of surgery or radiation.
Conversely, a high score in a patient initially classified as intermediate-risk can prompt a recommendation for treatment intensification, such as adding hormone therapy to radiation. The test’s ability to reclassify risk helps physicians identify patients who benefit from more aggressive upfront treatment to prevent future recurrence.
In the post-prostatectomy setting, the Decipher score determines the need for immediate adjuvant therapy. For patients with adverse features—such as positive surgical margins or extracapsular extension—the genomic result guides the decision to proceed with early salvage radiation or hormonal therapy. A high Decipher score strongly indicates an elevated risk of metastasis, requiring these additional treatments.