Prostate cancer breakthrough as test reveals which men could see their risk of death cut in half

Thousands of men with high-risk prostate cancer could soon live longer, thanks to a genetic test that helps doctors identify which patients require more aggressive treatment. 

Prostate cancer is now the most common cancer in men – with around 64,000 men diagnosed with the disease each year in the UK alone.

Yet doctors still face a difficult balancing act between identifying patients who will benefit from aggressive treatment, and those who may experience debilitating side-effects without significant improvement.

Research has shown that adding a type of hormone therapy – called abiraterone – to standard treatment for men with the disease could cut their risk of dying from the disease in half.

The drug, which blocks the production of testosterone, was rolled out on the NHS in England in earlier this year after being adopted in Wales and Scotland.

But doctors currently have no reliable way to identify which men stand to gain from the treatment, meaning some may experience side-effects including fatigue, liver damage and urinary tract infections with little added benefit. 

Now experts at University College London (UCL) say a test that analyses tumour tissue – that’s been extracted previously during biopsy – and help doctors determine which patients are most likely to benefit. 

‘Abiraterone saves lives but we may currently be over-treating some patients with this therapy,’ Dr Sarah Howlett, the study’s lead author, told the Daily Mail.

‘With this test, we can identify which patients need the treatment most and avoid it for those who don’t, giving doctors more of an idea of which patients are at the highest risk of their cancer returning.’ 

Results from the STAMPEDE trial suggest the test, known as Decipher, can identify which patients are most likely to respond to the hormone therapy. 

The study – presented at the European Society for Medical Oncology Congress, Madrid – analysed data from more than 30,000 men. 

The test analyses the activity of 22 genes within tumour tissue to estimate how aggressive a patient’s cancer is.

It is carried out using tissue already collected during a biopsy or prostate operation, meaning no additional procedures are required.

Patients receive a score between 0 and 1, with higher scores indicating a greater risk of the cancer spreading or returning after treatment.

Men with lower scores, by contrast, may be less likely to require more intense treatment.

The researchers found that higher scores consistently predicted poorer outcomes.

Each 0.1 increase in the Decipher score was associated with a 49 per cent higher risk of the cancer spreading to distant organs and a 38 per cent higher risk of dying from prostate cancer.

The team concluded the test could help doctors better target intensive treatment at those who need it most, while sparing others unnecessary side-effects.

‘For men with very high-risk prostate cancer, preventing the cancer from spreading is critical, and understanding who benefits most from additional treatment can make a meaningful difference,’ Dr Howlett said. 

‘Our findings suggest that a genomic test could help personalise treatment: men with high-risk disease but a low Decipher score have low rates of cancer spread and could potentially be spared more intensive treatment, while men with a high score could be prioritised for it.’

However, she cautioned that larger studies are still needed before the test can be routinely used to inform treatment decisions.

Elai Davicioni, medical director, at Veracyte, which makes the Decipher test, added: ‘We believe this growing evidence gives physicians a stronger reason to use Decipher before making decisions that can affect both cancer outcomes and patients’ quality of life.’