A tissue-based molecular test called Decipher could help doctors determine which men with high-risk prostate cancer actually need aggressive hormone therapy — and which ones can skip it and avoid the side effects that come with it.
Researchers at University College London analyzed the test’s ability to predict outcomes for patients considering abiraterone, a hormone therapy that the STAMPEDE clinical trial showed cuts the risk of death in half for men with high-risk, localized prostate cancer. The findings were presented at the European Society for Medical Oncology Congress 2026 in Madrid, held Oct. 23–27.
Not every man’s cancer behaves the same way, and treating someone more aggressively than his disease requires can mean needless side effects and a worse quality of life, according to a UCL news release. Because prostate cancers differ at the molecular level, hormone therapy doesn’t benefit every patient equally.
To test whether Decipher could guide that decision, researchers reviewed scores from more than 27,000 patients using real-world data, plus 401 men with non-metastatic prostate cancer who took part in the STAMPEDE abiraterone trial.
Higher Decipher scores predicted worse outcomes — meaning the cancer was more likely to spread, which signals that additional treatment could be worthwhile. Lower scores suggested that more intensive treatment may not be necessary at all.
Lead researcher Dr. Sarah Howlett of UCL Cancer Institute said that for men with very high-risk prostate cancer, stopping the disease from spreading is critical.
“Understanding who benefits most from additional treatment can make a meaningful difference,” Howlett said.
Men with high-risk prostate cancer and low Decipher scores may face a lower risk of the disease spreading and could avoid more intensive therapy altogether, while those with high scores appear to be the strongest candidates for additional treatment, according to the findings.
Howlett noted that seeing the same pattern show up in both a large real-world dataset and a randomized clinical trial strengthens confidence in the results. Still, she cautioned that further validation in other datasets is needed before the test is used routinely to make these treatment decisions.
Elai Davicioni, medical director of urology for Decipher’s maker, Veracyte, said the growing body of evidence gives physicians a stronger reason to use the test before making decisions that affect both cancer outcomes and patients’ quality of life.
Fox News senior medical analyst Dr. Marc Siegel, who was not involved in the study, said prostate cancer varies from person to person and that medical science is increasingly recognizing it is not a one-size-fits-all disease. He noted that localized prostate cancer can carry mutations that predict how aggressive it will be and whether it might respond to targeted therapies.
Siegel said certain targeted therapies, including more powerful anti-androgens that act on the adrenals as well as the testes, are being used more often with widespread prostate cancer. But hormone therapies carry significant side effects, including fatigue, and don’t always help.
He called the study’s design — combining a randomized treatment group with Decipher testing to identify in advance who would respond to intensive hormone therapy — a strength, and described it as the personalized, precise approach of the near future.
Prostate cancer is the second-leading cause of cancer death in men behind lung cancer, according to the American Cancer Society. About one in eight American men will be diagnosed with prostate cancer in his lifetime.
