The Role of Decipher Genomic Classifier in Prostate Cancer: Recent Validations and Clinical Implications

The VANDAAM study provides prospective validation that the Decipher genomic classifier predicts 2‑year biochemical recurrence after treatment for early localized prostate cancer.

The primary analysis used 2‑year biochemical recurrence and clinicopathologic adjustment to test the independent value of the genomic score; investigators reported robust overall discrimination with stronger performance in subgroup analyses, although they note the limited number of events and call for further validation.

These results should inform risk assignment and postoperative planning. The Decipher genomic classifier demonstrated stronger discrimination in African American patients than in the overall cohort, with higher AUCs and substantially greater adjusted odds of 2‑year recurrence for those in the high‑risk genomic group. In practice, the genomic score reclassified a small subset into a clearly elevated near‑term risk category while confirming low near‑term risk for many others.

Moving forward, guideline committees and implementation studies should evaluate whether routine early genomic testing changes pathways and outcomes, closing the loop from validation to practice. Further prospective implementation work will define whether this validation produces measurable outcome benefits.

Key Takeaways:

• Prospective validation of Decipher for 2‑year biochemical recurrence—supporting earlier genomic‑guided decisions on adjuvant therapy and surveillance.
• Patients undergoing postoperative risk stratification, notably African American patients who showed stronger genomic discrimination—consider prioritized testing in these groups.
• Pathology departments and tumor boards should add Decipher scores to postoperative reports and flag high‑risk results so teams can initiate timely adjuvant‑therapy discussions.