Genomic test may identify which prostate cancer patients benefit from added abiraterone

Men with high-risk, localised prostate cancer could soon have their treatment tailored with the help of a tissue-based genomic test, according to new findings from University College London researchers being presented at the European Society for Medical Oncology Congress 2026 in Madrid. The study examined whether the Decipher molecular test, which measures the activity of genes in tumour tissue, could identify which patients stand to gain the most from adding the hormone therapy abiraterone to standard treatment, and which might be spared the additional drug and its side effects, which include fatigue.

The analysis drew on two separate datasets. The first was real-world data covering 27,607 men, of whom 5,956 were analysed for outcomes. The second consisted of 401 men with non-metastatic prostate cancer who were randomised within the STAMPEDE abiraterone trial, a major UK clinical trial platform. Across both datasets, higher Decipher scores consistently predicted worse outcomes. For every 0.1 increase in the score, the risk of distant metastasis rose with an adjusted hazard ratio of 1.49, and the risk of dying of prostate cancer carried a hazard ratio of 1.38. Importantly, the score also predicted which patients whose cancers had not yet spread to their lymph nodes would benefit from the addition of abiraterone in preventing the cancer’s spread to distant parts of the body.

The findings arrive against a long-standing clinical dilemma. Prostate cancer, the most common cancer in men, affected more than one million men worldwide in 2013, and it does not behave the same way in every patient. Doctors have long faced a difficult balancing act between identifying patients who will benefit from more intensive treatment and those who may do just as well without it, because treating someone more aggressively than necessary is associated with increased side effects and poorer quality of life. In the UK, the standard treatment for prostate cancer is androgen deprivation therapy, and findings from the STAMPEDE trial have shown that adding abiraterone to this standard treatment for men with high-risk, localised disease could halve the risk of death from the disease and slow overall progression. However, not all trials have shown that adding extra hormonal therapies to high-risk prostate cancer is beneficial, which motivated the researchers to test whether Decipher could stratify patients more precisely.

Dr Sarah Howlett of the UCL Cancer Institute, the study’s lead researcher, who will present the findings at the Madrid congress, said the results point toward a more personalised approach. “For men with very high-risk prostate cancer, preventing the cancer from spreading is critical, and understanding who benefits most from additional treatment can make a meaningful difference,” she said. “Our findings suggest that a genomic test could help personalise treatment: men with high-risk disease but a low Decipher score have low rates of cancer spread and could potentially be spared more intensive treatment, while men with a high score could be prioritised for it.” She cautioned, however, that the pattern must hold up elsewhere: “Showing the same pattern in both a large real-world dataset and a randomised clinical trial strengthens the findings. But further validation in other datasets is needed before the test is used routinely to make these decisions.”

The study is described as experimental research on people, and its conclusions are associations and predictive signals rather than proof that changing treatment on the basis of the score improves survival; the researchers themselves note that routine use awaits further validation. The timing of the findings is nonetheless significant for UK patients. In January, NHS England announced it would roll out the use of abiraterone to treat men in England with high-risk locally advanced prostate cancer within weeks, and patients with similar risk profiles in Wales and Scotland already had access to the drug on the NHS. As abiraterone becomes more widely available, a test that distinguishes who genuinely benefits from adding it could influence both cancer outcomes and patients’ quality of life.

The diagnostics industry has also weighed in on the results. Elai Davicioni, medical director of Urology at Veracyte, the US cancer diagnostics firm that makes the Decipher test, said: “We believe this growing evidence gives physicians a stronger reason to use Decipher before making decisions that can affect both cancer outcomes and patients’ quality of life.” He added that the findings “expand Decipher’s predictive evidence to another consequential treatment decision: whether adding abiraterone will provide meaningful benefit for a man with very high-risk prostate cancer.” Because Veracyte manufactures the test, its commercial interest should be kept in view when interpreting the company’s endorsement, and independent validation in additional datasets remains the stated prerequisite before the score guides routine treatment decisions. The convergence of a large real-world cohort and a randomised trial, however, gives the signal a degree of consistency that future validation studies can now be designed to test directly.

Subject of Research: Use of the Decipher genomic test to predict benefit from abiraterone in high-risk localised prostate cancer

Article Title: Diagnostic test could help doctors refine prostate cancer treatment

Article References: Diagnostic test could help doctors refine prostate cancer treatment. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

DOI: Not provided

Keywords: prostate cancer, Decipher test, abiraterone, STAMPEDE trial, genomic testing, UCL, hormone therapy, distant metastasis, personalised medicine, ESMO 2026, NHS England, Veracyte