A molecular test called Decipher may soon help doctors decide which men with high-risk prostate cancer truly need aggressive hormone therapy — and which ones could safely skip it, according to new research presented at the European Society for Medical Oncology Congress 2026 in Madrid, held Oct. 23–27.
Researchers at University College London examined whether the tissue-based test could predict which patients would benefit from abiraterone, a hormone therapy shown in the STAMPEDE clinical trial to cut the risk of death in half for men with high-risk, localized prostate cancer. The drug is effective, but it carries real costs: hormone therapies can bring on fatigue and other significant side effects, and not every patient needs them.
The study drew on Decipher scores from more than 27,000 men in real-world data, along with 401 men who had taken part in the STAMPEDE abiraterone trial. The pattern held in both groups: men with higher Decipher scores had worse outcomes and a greater likelihood their cancer would spread, suggesting they stood to gain the most from additional treatment. Men with lower scores appeared less likely to need it.
“For men with very high-risk prostate cancer, preventing the cancer from spreading is critical,” said Dr. Sarah Howlett of UCL Cancer Institute, who led the research. “Understanding who benefits most from additional treatment can make a meaningful difference.”
Howlett said the fact that the pattern showed up consistently in both a large real-world dataset and a randomized trial strengthens confidence in the results, though she cautioned the test isn’t ready for routine use yet. “Further validation in other datasets is needed before the test is used routinely to make these decisions,” she said.
Elai Davicioni, medical director of urology for Veracyte, which makes the Decipher test, said the findings give doctors “a stronger reason to use Decipher before making decisions that can affect both cancer outcomes and patients’ quality of life.”
A push toward more individualized treatment
Fox News senior medical analyst Dr. Marc Siegel, who had no role in the study, said the research reflects a broader shift in how doctors think about the disease. “Prostate cancer varies from person to person,” he said. “Medical science is increasingly aware that it is not one size fits all.”
Siegel noted that localized tumors can carry mutations that signal how aggressive they’re likely to become and whether they might respond to targeted therapies. He also pointed to newer anti-androgen drugs now used more often against advanced prostate cancer, which act on the adrenal glands in addition to the testes — but said hormone treatments in general “don’t always help” and come with “significant side effects,” including fatigue.
What stood out about this study, Siegel said, was pairing a randomized treatment group with Decipher testing to identify beforehand which patients were most likely to respond to intensive hormone therapy. “This is the personalized, precise approach of the near future,” he said.
Prostate cancer is the second-leading cause of cancer death among men, behind lung cancer, according to the American Cancer Society. Roughly one in eight American men will be diagnosed with the disease during their lifetime.
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