Phase 3 STAMPEDE trial data demonstrates Decipher Prostate test can predict docetaxel treatment benefit, potentially helping patients avoid unnecessary toxicity.
A genomic classifier can help identify which patients with metastatic prostate cancer are likely to benefit from chemotherapy treatment intensification and which can avoid unnecessary toxicity, according to new data from a large-scale clinical trial.
The findings, published in Cell, show that the Decipher Prostate Genomic Classifier successfully predicted treatment response to docetaxel chemotherapy in patients with metastatic prostate cancer enrolled in the randomized, Phase 3 STAMPEDE trial. The study represents the first published evidence that a gene expression test can help personalize chemotherapy decisions for this patient population.
Veracyte Inc and University College London (UCL) collaborated on the research, which analyzed data from 832 patients with metastatic prostate cancer who were followed for a median of 14 years. Patients with higher Decipher Prostate scores showed improved survival benefit from docetaxel treatment (HR 0.64, 95% CI 0.48-0.86), while those with lower scores did not benefit (HR 0.96, 95% CI 0.71-1.30; biomarker-treatment interaction p=0.039).
“Our findings suggest that the Decipher Prostate test may provide an important new tool to help guide treatment decisions for the growing population of patients with metastatic prostate cancer,” says professor Gerhardt Attard, MD, PhD, director of UCL Cancer Institute and STAMPEDE trial co-investigator, in a release. “Treatment intensification with docetaxel, in addition to standard-of-care androgen deprivation therapy, is shown to improve survival for patients with metastatic prostate cancer. However, response rates vary and clinicians have had limited tools to identify who will likely benefit and who will not.”
Test Performance Consistent Across Disease Volumes
The study involved 1,523 patients with high-risk or metastatic prostate cancer randomized to receive either standard androgen deprivation therapy (ADT) alone or chemotherapy plus ADT. Importantly, the genomic test’s predictive ability remained consistent regardless of each patient’s metastatic disease volume, which differs from current clinical practice that typically favors docetaxel use in patients with high-volume but not low-volume disease.
The 22-gene Decipher test uses RNA whole-transcriptome analysis and machine learning to assess cancer aggressiveness from biopsy or surgically resected samples. For metastatic cases, the test score indicates likelihood of cancer progression and survival benefit with treatment intensification.
“The Decipher Prostate test’s ability to help guide treatment for patients with localized prostate cancer has already been established in dozens of peer-reviewed publications, and it is the only gene expression test to achieve ‘Level I’ evidence status in the most recent NCCN Guidelines for prostate cancer,” says Elai Davicioni, PhD, Veracyte’s medical director for Urology, in a release.
Commercial Availability and Future Applications
Veracyte began making the Decipher test for metastatic prostate cancer broadly available to US clinicians in June 2025. The expanded-use test was developed through the ongoing collaboration between Veracyte and University College London.
The research also identified potential opportunities for further treatment personalization. Metastatic tumors with both high Decipher Prostate test scores and a PTEN-inactive gene signature showed the greatest benefit from docetaxel addition, suggesting possibilities for even more targeted patient selection in the future.
“The recent introduction of the Decipher test for metastatic prostate cancer reinforces the power of our Veracyte Diagnostics Platform,” says Phil Febbo, MD, Veracyte’s chief scientific officer and chief medical officer, in a release. “This platform helps harness our whole-transcriptome data-generation capabilities and our commitment to partnering with the research community to advance cancer understanding and innovation.”
The clinical need for better treatment selection tools is significant. Globally, nearly 1.5 million new prostate cancer cases are diagnosed annually, with the disease accounting for nearly 400,000 cancer-related deaths in men. In the US, nearly 315,000 patients will be diagnosed with prostate cancer this year, making it the second-leading cause of cancer deaths among men.
The Decipher Prostate test’s clinical utility has been demonstrated in more than 90 studies involving over 200,000 patients across the full spectrum of prostate cancer care.
Photo caption: Decipher Prostate test
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