University Hospitals Seidman Cancer Center researchers Demonstrate Veracyte’s Decipher Prostate Test Predicts Benefit from Adding Hormone Therapy to Radiation

Lead author, Dr. Angela Jia, MD, PhD, presented randomized Phase III results at ASTRO 2026

CLEVELAND - Researchers from University Hospitals Seidman Cancer Center presented randomized phase III findings from leading cancer diagnostic company Veracyte at the American Society for Radiation Oncology (ASTRO). The trial evaluated dose-escalated radiation with or without short-term androgen deprivation therapy (ADT) in men with intermediate-risk prostate cancer. The analysis showed that the Decipher Prostate Genomic Classifier can predict which patients are more likely to benefit from adding short-term ADT to dose-escalated radiation, providing both Level 1B¹ prognostic and predictive evidence.

In the study, patients with higher Decipher scores had substantially improved outcomes with the addition of short-term ADT to radiation, while patients with low Decipher scores derived minimal treatment benefit.

These findings extend Decipher’s long-established role in assessing the risk of prostate cancer progression to informing treatment selection for patients with intermediate-risk disease.

"For men with intermediate-risk prostate cancer, the question is not simply whether hormone therapy works — it is who truly needs it," said lead author, Angela Jia, MD, PhD, radiation oncologist, UH Seidman Cancer Center. "This analysis suggests tumor biology can distinguish patients who may achieve a substantial reduction in the risk of distant metastasis from those who may see little added benefit. That could help clinicians and patients make a more individualized decision about intensifying treatment."

While ADT can reduce the risk of recurrence and distant spread, it can also have metabolic and quality-of-life effects. Because intermediate-risk disease is biologically diverse, clinical variables such as Gleason grade, PSA or clinical stage may not reveal which patients are most likely to benefit from adding the therapy.

Key study findings:

• Decipher predicted differential benefit from hormone therapy: The treatment-by-Decipher interaction for distant metastasis was statistically significant (p<0.001).
• Patients with higher scores experienced substantially greater benefit: Among patients with intermediate/high Decipher scores, adding short-term ADT was associated with an 8% absolute reduction in distant metastasis at 10 years.
• Patients with low scores did not have substantial benefit from short-term ADT: Among the 44% of patients with low Decipher scores, the absolute difference in 10-year distant metastasis was 1 percentage point.

Decipher also refined prognosis: Higher scores were independently associated with greater risk of biochemical failure, distant metastasis and prostate-specific mortality. Researchers analyzed tumor samples from 395 patients enrolled in NRG/RTOG 0815, with a median follow-up of 10.2 years. The biomarker cohort was representative of the overall trial enrollment of 1,492 patients and was balanced between treatment arms. The Decipher score was both prognostic for disease outcomes and predictive of ADT benefit for both distant metastasis as well as prostate cancer specific mortality endpoints.

“For men with intermediate-risk prostate cancer, these findings provide predictive evidence that treatment decisions can be guided by the biology of each patient's tumor, not simply a broad clinical risk category,” said Daniel E. Spratt, MD, chair of the Department of Radiation Oncology at University Hospitals Cleveland Medical Center, the Vincent K. Smith Chair in Radiation Oncology, UH Seidman Cancer Center and a study author. “Decipher may help identify who is likely to gain meaningful protection from metastasis by adding hormone therapy and who may face its health and quality-of-life effects with little added benefit. That is the kind of precision that patients and physicians need when deciding how aggressively to treat the cancer.”