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Prognostic Implications of Very High Decipher Scores in Prostate Cancer: Towards a Refined Genomic Risk

Rohan Sharma1, Marcio C Moschovas1, Seetharam K R Bhatt2

  • 1Global Robotics Institute, AdventHealth, Celebration, FL, USA.

European Urology Oncology
|October 9, 2025
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Summary

The 22-gene Decipher genomic classifier (DGC) identifies a very high-risk (VHR) group (>0.85) associated with worse outcomes after prostatectomy. Integrating DGC with other scores improves risk prediction for personalized treatment.

Keywords:
Biochemical recurrenceDecipher genomic classifierGenomicsPrognosisProstate cancerRadical prostatectomy

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Area of Science:

  • Oncology
  • Genomics
  • Prostate Cancer Research

Background:

  • The 22-gene Decipher genomic classifier (DGC) is utilized for prostate cancer risk stratification.
  • A novel very high-risk (VHR) group defined by DGC score >0.85 requires evaluation for recurrence outcomes post-radical prostatectomy (RP).

Purpose of the Study:

  • To assess the association of the DGC VHR group with recurrence after RP.
  • To evaluate the impact of integrating DGC scores with CAPRA-S and EAU risk groups for improved prognostication.

Main Methods:

  • Retrospective analysis of 1673 patients undergoing RP (2015-2022).
  • Categorization of DGC scores into low, intermediate, high, and VHR groups.
  • Kaplan-Meier analysis and log-rank tests for biochemical recurrence (BCR); combination with CAPRA-S and EAU risk groups.

Main Results:

  • Adverse pathological features increased with higher DGC scores (p < 0.001).
  • DGC VHR independently predicted BCR (HR 1.70, p=0.008).
  • Combined DGC and CAPRA-S/EAU models demonstrated superior risk stratification and net benefit.

Conclusions:

  • A DGC score >0.85 identifies a distinct subgroup with significantly adverse oncologic outcomes.
  • The VHR category refines postoperative assessment for prostate cancer.
  • Personalized adjuvant or salvage therapy can be supported by this enhanced risk stratification.