ASCO GU 2023: Geographic Variation of Decipher® Genomic Classifier in Patients with Early Prostate Cancer

( The 2023 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between February 16th and 18th was host to a prostate cancer poster session where Dr. Daniel Keizman presented his group’s study evaluating the geographic variation of Decipher® genomic classifier in patients with early prostate cancer.

The influence of environmental and/or lifestyle factors on the epigenetic expression profile of prostate cancer-related genes has long been proposed. These extrinsic variables may help modulate prostate cancer pathogenesis, progression, and eventually survival outcomes. As such, the evaluation of geographic variations of prostate cancer genomic risk profiles is important to further the understanding of disease heterogeneity. Decipher® (Decipher Biosciences, San Diego, CA, USA) is 22-gene genomic classifier that has been used to risk stratify patients in both the pre- and post-operative settings.1 To date, there is no data reporting on the geographic variation of this test. The authors aimed to evaluate Decipher® genomic score results among Israeli patients, in comparison to American patients.

The authors utilized the Decipher® database, which hosts data from patients who have given consent for broad data sharing. The authors identified and analyzed Decipher® test scores for Israeli patients with localized prostate cancer and subsequently matched those patients to a corresponding cohort of American patients.

This case-control study included 144 patients (median age 69.5 years, range 64 to 74). With respect to NCCN risk grouping, 61 patients (42.4%) were low, 56 (38.9%) favorable intermediate, 25 (17.4%) unfavorable intermediate, and two (1.4%) high risk patients. The median Decipher® score was 0.57 (Interquartile range: 0.39 to 0.82). Decipher risk grouping was low in 61 (38.1%), intermediate in 27 (16.9%), and high in 72 (45%). The median Decipher® score was positively correlated with Grade Group disease.

There was significant discordance between NCCN risk grouping and Decipher® risk scores. Almost half of NCCN low risk patients (46%) had a higher risk Decipher® score. 82% of patients in the NCCN favorable and unfavorable intermediate risk groups were reclassified to lower or higher risk. Conversely, 9% of NCCN high risk patients had a lower risk as per Decipher®.

With respect to geographic variations between the two cohorts of patients, a higher proportion of “high” Decipher® scores were observed in Israeli patients when compared to those in the US population (n=43065) in the Decipher® database (Median 0.43 versus 0.57 in Israeli patient: IQR: 0.27 to 0.66; 52%/18%/30% with low/intermediate/high risk).

The authors concluded that preliminary results from this study suggest a higher proportion of high risk Decipher® scores among Israeli patients with localized prostate cancer. At the given time, these results should be interpreted cautiously given that the study is currently still ongoing.

Presented by: Daniel Keizman, MD, Head of Genitourinary Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, San Francisco, CA, February 16th – February 18th, 2023


  1. Jairath NK, et al. A Systematic Review of the Evidence for the Decipher Genomic Classifier in Prostate Cancer. Eur Urol 2021;79(3):374-383. 

Related Content:
A Systematic Review of the Decipher® Genomic Classifier in Prostate Cancer - Ashley Ross & Daniel Spratt