Clinical Comparison of Decipher 1.0 and 1.1 for Localized Prostate Cancer: Results in Prostatectomy and Active...

Decipher is a 22-gene genomic risk classifier that utilizes a whole-transcriptome microarray assay to provide a score ranging from 0 to 1. Recently, the individual gene scores that defined Decipher v1.0 were reweighted to define updated Decipher v1.1. Our objective was to assess the impact of that change in a large institutional cohort database with active surveillance (AS)- and radical prostatectomy (RP)-specific outcomes. The dual primary outcomes included a major biopsy upgrade to Gleason grade group ≥3 after AS and prostate cancer recurrence after RP. Of 1579 patients, 974 underwent RP and 605 enrolled on AS. Decipher v1.1 scores (median 0.34; interquartile range [IQR] 0.22, 0.50) were lower on biopsy than on Decipher v1.0 (median 0.45; IQR 0.34, 0.59; p < 0.01). A high Decipher v1.1 score was associated with a higher risk of a major biopsy upgrade on AS (>0.6 vs <0.4; hazard ratio 2.11 [95% confidence interval 1.14-3.89]), while Decipher v1.0 was not. The median Decipher scores on prostatectomy were 0.64 (v1.0) and 0.61 (v1.1). A high Decipher score was associated with a higher risk of recurrence after RP for both v1.1 and v1.0. In summary, Decipher v1.1 scores tend to be lower than those of Decipher v1.0 and better predict the risk of a major biopsy upgrade on AS.