New genomic test could help personalise prostate cancer treatment, study suggests

Decipher test measures tumour aggressiveness and could identify men who would benefit from intensive therapy while sparing others from side effects

By LineZotpaper

Published23 October 2026

Read Time2 min

A novel genomic test could help doctors identify which men with high-risk prostate cancer need more aggressive treatment and which could safely avoid it, according to new research led by University College London that will be presented at the European Society for Medical Oncology Congress 2026 in Madrid.

The study, which analysed Decipher test scores for more than 6,000 men, found that higher scores consistently predicted worse outcomes and could identify patients whose disease had not yet spread to lymph nodes but would still benefit from the hormone therapy abiraterone to prevent further spread.

Decipher works by analysing cellular genetics from a small portion of an existing tissue biopsy, measuring how aggressive a tumour is and evaluating its likelihood of spreading. It produces a score ranging from calm and less likely to spread to aggressive with a high risk of spreading.

The research follows earlier findings from UCL that combining standard treatment with abiraterone, which stops testosterone from fuelling the cancer, halved mortality risks and slowed disease progression in high-risk cases.

Dr Sarah Howlett of the UCL Cancer Institute said: “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. 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. 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.”

In January, NHS England widened eligibility for abiraterone to include men whose high-risk cancer has not yet spread, after it was previously only available to those with advanced disease.

Elai Davicioni, medical director of urology at Veracyte, which 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. These 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.”

Analysis

Why This Matters

Prostate cancer is one of the most common cancers in men, and treatment decisions can mean the difference between life and death, or unnecessary side effects from intensive therapy.
If validated, Decipher could help doctors target aggressive treatments like abiraterone to those who will benefit most, while sparing others from side effects such as fatigue, hot flushes, and hormone-related complications.
The test could also help the NHS allocate costly treatments more efficiently, as abiraterone has recently been widened to more patients.

Background

Prostate cancer varies widely in how aggressively it grows. Some tumours remain slow-growing and never cause harm, while others spread quickly and become deadly. Standard practice has relied on clinical features like PSA levels and Gleason scores to estimate risk, but these do not always accurately predict who will progress. Genomic tests like Decipher aim to add precision by analysing the tumour's biology directly. The findings come as abiraterone, a hormone therapy that blocks testosterone, is being made available to more men in England with high-risk but non-spread cancer.

Key Perspectives

Clinicians and researchers (UCL): The test could personalise treatment, identifying men who need intensive therapy and those who do not. But further validation in other datasets is needed before routine use. Veracyte (Decipher maker): The growing evidence supports using Decipher before treatment decisions that affect both outcomes and quality of life. Patients and health systems: Wider access to abiraterone increases treatment options but also raises questions about cost-effectiveness and the need to avoid overtreating men who will do well with standard care alone.

What to Watch

Further validation studies in diverse patient groups, outside the original dataset.
Whether NICE or NHS England formally recommend Decipher for guiding abiraterone use.
Uptake of genomic testing in NHS prostate cancer pathways.

Sources

New test could detect men who would benefit from intensive prostate cancer treatment · The Independent UK

Checked

11 claims in this story checked against 1 source: 8 supported.

Show each claim

SupportedA genomic test could help personalise prostate cancer treatment.The Independent UK: “Our findings suggest that a genomic test could help personalise treatment”
Partly supportedThe Decipher study was led by UCL and will be presented at the 2026 ESMO Congress in Madrid.The Independent UK: “The findings follow research led by University College London, which revealed that combining standard treatment with the hormone therapy abiraterone”
Partly supportedThe test could identify men who need more aggressive treatment and those who could safely avoid it.The Independent UK: “A novel diagnostic test could enable doctors to identify prostate cancer patients in need of more aggressive care while protecting others from the side effects of redundant therapies”
SupportedThe study looked at Decipher scores for more than 6,000 men.The Independent UK: “researchers looked at Decipher scores for more than 6,000 men.”
SupportedHigher Decipher scores consistently predicted worse outcomes.The Independent UK: “They found higher scores consistently predicted worse outcomes.”
SupportedThe scores predicted which men whose cancer had not spread to lymph nodes would benefit from abiraterone to prevent further spread.The Independent UK: “The score also predicted which patients whose disease had not yet spread to their lymph nodes and would benefit from abiraterone to prevent further spread.”
SupportedDecipher analyses genetics from a small portion of an existing biopsy to assess tumour aggressiveness and spread risk, producing a score from less to more aggressive.The Independent UK: “By analysing cellular genetics using a small portion of an existing tissue biopsy, the test measures how aggressive a tumour is and evaluates its likelihood of spreading. The test transforms this data into a score”
SupportedHowlett said preventing spread is critical and that understanding who benefits from additional treatment can make a meaningful difference.The Independent UK: “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.”
SupportedEarlier UCL-led research found abiraterone halved mortality risks and slowed disease progression in high-risk cases.The Independent UK: “combining standard treatment with the hormone therapy abiraterone — which works by stopping testosterone from fuelling the cancer — halved mortality risks and slowed disease progression in high-risk cases.”
Partly supportedNHS England widened abiraterone eligibility in January to men with high-risk cancer that had not spread; previously it was available only to men with advanced disease.The Independent UK: “It was previously only available to those whose cancer had spread, but NHS England widened this to include men whose high-risk cancer had not yet spread.”
SupportedDavicioni said the findings give physicians a stronger reason to use Decipher before treatment decisions affecting outcomes and quality of life.The Independent UK: “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.”