Comparative analysis of National Comprehensive Cancer Network risk stratification and the Decipher genomic classifier in prostate adenocarcinoma

Abstract

Objective:

To evaluate the clinical utility of the Decipher genomic classifier in prostate biopsy specimens and its association with National Comprehensive Cancer Network (NCCN) risk stratification, metastatic outcomes, and racial differences.

Patients and Methods:

We retrospectively reviewed 88 patients with prostate adenocarcinoma who underwent Decipher testing on diagnostic biopsy tissue between 2021 and 2023. Clinical variables, Decipher risk categories, and NCCN risk groups were compared using chi-square, t-test, analysis of variance (ANOVA), and logistic regression to assess their association with distant metastasis.

Results:

Decipher risk categories showed moderate concordance with NCCN classification (Phi = 0.46, p < 0.001). Forty-five percent of patients were Decipher low risk, 30% intermediate risk, and 25% high risk. During follow-up, seven patients (8%) developed distant metastasis; four had high-risk, two intermediate-risk, and one low-risk Decipher scores. Decipher high-risk classification was more common among African American patients than Caucasian patients (44% vs 19%, p = 0.04). The receiver operating characteristic (ROC) curve showed moderate discriminative performance (area under the curve (AUC) = 0.70).

Conclusion:

Decipher testing on prostate biopsy specimens provides prognostic information beyond NCCN classification and may help identify biologic differences across racial groups, supporting its integration into personalized risk assessment.

Level of evidence:

3