For those with prostate cancer, the Decipher score is a tool that helps create a clearer picture of an individual’s specific cancer. It is part of a shift toward more personalized medicine. Understanding what this score represents, especially when it is in the “high-risk” category, is a step toward making more informed health decisions with your healthcare provider.
Prostate Cancer: Why Predicting Aggressiveness Matters
Prostate cancer originates in the prostate gland. Not all prostate cancers behave in the same way; many grow so slowly they may never cause significant harm. Others are aggressive and can spread quickly to other parts of the body. This variability in behavior is a challenge in managing the disease.
Doctors have long used tools like the Prostate-Specific Antigen (PSA) blood test and the Gleason score from a biopsy. While these methods provide information about the cancer’s presence and characteristics, they may not capture the full picture of a tumor’s potential. Two individuals with similar clinical factors can have very different outcomes.
This uncertainty makes it difficult to decide between immediate aggressive treatment, which has side effects, and active surveillance. Active surveillance involves closely monitoring the cancer. Advanced diagnostic tools offer a deeper look into a tumor’s biology to better predict its future behavior.
What is the Decipher Test for Prostate Cancer?
The Decipher test is a genomic classifier that provides a detailed risk assessment by analyzing the genetic material within the tumor itself. It is performed on a small sample of prostate tissue already collected during a biopsy or after surgery (radical prostatectomy). This means no additional invasive procedure is needed to conduct the test.
The test measures the activity level of 22 RNA biomarkers inside cancer cells. RNA is a molecule that carries instructions from genes to the rest of the cell. These specific biomarkers are involved in biological processes known to drive cancer growth and spread. This includes cell cycle progression, immune system response, and the formation of new blood vessels that feed a tumor.
By analyzing the combined activity of these genes, the Decipher test provides an individualized assessment of a tumor’s biological potential for aggression. The test’s goal is to predict the likelihood of metastasis, which is the spread of cancer to other parts of the body. This information adds precision to the clinical picture, helping to clarify risk for patients in low or intermediate-risk categories.
What a High-Risk Decipher Score Signifies
Decipher test results are presented as a score on a scale from 0 to 1, with a higher score indicating a greater probability of the cancer spreading. This score is categorized into risk groups. A score of 0 to 0.45 is low-risk, 0.45 to 0.6 is intermediate-risk, and a score above 0.6 is classified as high-risk.
A high-risk Decipher score means the tumor’s genomic profile shows characteristics associated with aggressive behavior. It suggests a higher likelihood that the cancer will metastasize within the next five to ten years. The test report provides a percentage risk for metastasis at 5 years and the risk of dying from prostate cancer at 10 and 15 years. A high score translates into higher percentages for these outcomes.
This score is prognostic, not diagnostic; it predicts the future behavior of an already diagnosed cancer. The score is determined by the tumor’s genomic information, independent of factors like PSA level or Gleason score. This provides a unique piece of information about the tumor’s inherent aggressiveness.
How a High-Risk Score Impacts Treatment Choices
A high-risk Decipher score has direct implications for treatment planning. It helps personalize treatment by matching the therapy’s intensity to the tumor’s aggressiveness. This information helps determine if it is safe to monitor the cancer or if more immediate action is needed.
For men who are candidates for active surveillance, a high-risk score often shifts the recommendation toward definitive treatment. Active surveillance may be deemed too risky for a tumor with aggressive genomic features. Instead, treatments like surgery to remove the prostate or radiation therapy would be more strongly considered to eliminate the cancer before it can spread.
After surgery, a high-risk score can influence the decision to add further therapy. A patient with a high Decipher score after prostate removal may be advised to undergo radiation and possibly androgen deprivation therapy (ADT), also known as hormone therapy. The score indicates a higher chance of recurrence, and these additional treatments can help reduce that risk. This provides a rationale for intensifying treatment to counter the tumor’s aggressive biology.