Decipher Prostate test predicts abiraterone benefit in Phase III

Veracyte has reported that its Decipher Prostate Genomic Classifier can predict which men with clinically very high-risk nonmetastatic prostate cancer are most likely to benefit from adding abiraterone to androgen deprivation therapy (ADT). The findings, drawn from a retrospective analysis of the randomised Phase III STAMPEDE trial, were presented at the European Society for Medical Oncology Congress 2026 on 24 October by Dr Sarah Howlett of University College London.

The analysis, covering 401 patients who received either ADT alone or ADT plus abiraterone, demonstrated a statistically significant treatment-by-Decipher interaction for distant metastasis among node-negative patients (p=0.01). At five years, patients with high Decipher scores saw a 10 percentage-point absolute reduction in distant metastasis events when abiraterone was added, and those with very high scores saw an 11-point reduction, compared with a 2-point reduction for patients with lower scores. A separate real-world analysis of more than 27,000 patients reinforced the test's prognostic value across NCCN high- and very high-risk clinical groups.

Clinical significance

Dr Howlett said the analysis shows that the Decipher test "can identify which patients in this study population were at greatest risk of prostate cancer-specific mortality and, therefore, may gain the greatest benefit from adding abiraterone to ADT." That is a materially different question from prognosis alone: abiraterone improves outcomes when added to ADT but also increases side-effect burden, and knowing in advance who benefits most allows physicians and patients to weigh the trade-off more precisely.

Elai Davicioni, Veracyte's medical director for urology, said the results "strengthen Decipher's role in helping physicians connect tumour biology to treatment selection across the prostate cancer risk continuum," building on predictive data presented earlier this year in intermediate-risk disease at ASTRO.

Veracyte noted that the evidence base will continue to grow: the prospective Phase III NRG-GU009 (PREDICT-RT) trial, which completed enrolment earlier in 2026, is designed to evaluate Decipher-guided treatment intensification or de-intensification using apalutamide, a different androgen receptor pathway inhibitor. Prospective data from PREDICT-RT will provide a higher level of evidence than the retrospective STAMPEDE analysis, and its readout is expected to be a key catalyst for broader adoption of the test.

Market and regulatory context

Decipher Prostate is already embedded in clinical guidelines: prior STAMPEDE analysis was incorporated into the NCCN 2027 prostate cancer guidelines for high- and very high-risk disease earlier this year. The latest findings extend the predictive claim into the specific question of abiraterone intensification, a decision point that affects a meaningful proportion of the roughly 300,000 men diagnosed with prostate cancer annually in the United States alone.

The genomic classifier market for prostate cancer has become increasingly competitive, with Oncotype DX Genomic Prostate Score and the Prolaris test among the other commercially available options. Veracyte's strategy of generating evidence across multiple risk strata and treatment decisions, rather than focusing on a single clinical question, is positioning Decipher as a potential companion-diagnostic-adjacent tool ahead of any prospective label expansion. Whether payers follow guideline inclusion with broader reimbursement coverage will be the near-term commercial test.