Recurrent prostate cancer is usually treated with radiation alone or with the addition of hormone therapy. Doctors currently use certain criteria—like tumor grade and PSA level—to recommend whether patients with recurrent prostate cancer should get hormone therapy in addition to radiation. But studies have shown that these characteristics aren’t very good at identifying people who truly need the combination treatment. Because hormone therapy can cause distressing side effects—including hot flashes, loss of energy, and loss of sexual desire—the treatment is typically reserved for patients with aggressive cancer that is more likely to spread. Therefore it’s currently challenging to determine which patients have aggressive cancer that may require the addition of hormone therapy.
A new study found that the genetic biomarker test, called Decipher, may have the ability to do just that. The test looks at the activity of 22 genes in prostate tumor tissue and calculates a “risk of metastasis” score ranging from 0-0.45 (low), 0.45-0.6 (intermediate) and 0.6 – 1.0 (high). Using data from an NCI-sponsored clinical trial, researchers found that people with higher Decipher scores were more likely to have cancer that spread years later and to die from the cancer. The results, published February 11 in JAMA Oncology, also showed that hormone therapy helped people with higher scores live longer but was far less helpful for those with lower scores. For a more specific description of the Decipher test scores, see the following link to an article published March 15th by the National Cancer Institute Current Cancer Blog. A blog first describing Decipher was posted on this website in 2017.
Although the Decipher test was developed nearly a decade ago, the new findings are important because previously there wasn’t enough evidence to recommend its routine use in patient care. Decipher is already available to patients and the cost is covered by many insurance payers, including Medicare. Plus, it doesn’t require an additional procedure if tumor tissue is readily available from the patient’s prostate surgery. There are still many questions about how to use the Decipher test in different groups of patients with prostate cancer. About 20 ongoing clinical studies are looking to provide some answers.