The Decipher Prostate Genomic Classifier is the clinical product, but it is derived from the Decipher Genomic Resource Information Database (Decipher GRID). To understand the future of prostate cancer care, we must understand the relationship between the product and the platform.
I completely agree with you. Thankfully, the one size fits all is steadily declining. But we need more physicians who treat prostate cancer to better understand all these tools available to them. And for checks and balances, savvy patients who educate themselves and then strongly advocate for themselves.
The Decipher test requires a sample of either your prostate from a biopsy or from the prostate that was surgically removed. Or from a biopsy of a metastatic lesion. You could check with your physician to see if there is tissue available to send off for a Decipher test. Pathology labs retain the pathology slides and tissue samples.
While some (ok a lot) of this went over my head, this sounds like a really exciting development in the diagnosis and treatment for PCa. I'll have to ask my urologist if it's still possible to get a Decipher test from my prostate that was removed in September 2024. I always appreciate your posts, Keith. Thanks for another fascinating one!
As someone who treats patients with prostate cancer with minimally invasive/focal therapies, I find the DECIPHER data particularly useful primarily for lower grade prostate cancers that can be safely watched but not treated. I am hopeful that further mining of this data will better tell us who DOES NOT need treatment which I believe is a large group of men given this diagnosis every year— the so-called “benign malignancy” group.
I am amazed that many of my seasoned urology colleagues do not believe in this testing and I have received pushback from such colleagues when I advocate this testing for mutual patients. Why?
1) Some say the data does not represent all patient groups due to varying demographics and may be “dated” as it was accumulated many years ago. I do not agree with this given the enormity of the Decipher GRID
2) Some object to the proprietary nature of the database and ability to monetize prognosis at such a large scale (i.e “23 and me” phenomena
Hi Eric. There will always be docs who don't believe in something, mainly because they don't "experiment" with it to honestly understand how it works. Lots of docs are using Decipher Prostate to help decide if active surveillance is indicated or not. I totally agree we need more tools to determine who not to treat. The more I read about the GRID the more I feel it has enormous potential. It's data is mostly Euro-centric and we definitely need more data from trialswith black men. Sadly that's the case across the board with clinical trials for prostate cancer. I'll probably do another post on the GRID because there is some interesting stuff I left off because the post was getting too long. And the report itself is very cool. Thanks for following and commenting.
Less torture, more success. Let's hope the government doesn't defund. I wonder how defunding has already affected knowledge. My prayers and best wishes always through your torturous Journey.
This is an excellent explainer, and I appreciate how you separate the clinical product (a 22-gene prognostic score) from the platform (the transcriptomic “factory” that keeps learning). That distinction is often missed and it’s where the real future of precision oncology lives. From a clinician’s lens, the promise here isn’t “more data,” it’s better decisions: identifying who truly needs treatment escalation versus who can safely de-escalate. That’s especially important in prostate cancer, where the harms of overtreatment (urinary/sexual side effects, fatigue, financial toxicity) can be profound. The shift you highlight, from prognostic to predictive signatures (therapy selection, radiation dosing, etc.) is exactly the direction we need. I also appreciate your implied caution: research-use outputs can be informative, but they still need rigorous prospective validation, transparent performance across diverse populations, and clear guardrails for how clinicians should (and shouldn’t) act on them. Really valuable post! This is the kind of systems-level thinking that can reduce “torture” and improve outcomes at scale.
Thank you for this post. I just received my Decipher report indicating .82 high risk. I have requested that we get the GRID info now also to discern the best path forward.
I completely agree with you. Thankfully, the one size fits all is steadily declining. But we need more physicians who treat prostate cancer to better understand all these tools available to them. And for checks and balances, savvy patients who educate themselves and then strongly advocate for themselves.
What if you don't have a prostate?
The Decipher test requires a sample of either your prostate from a biopsy or from the prostate that was surgically removed. Or from a biopsy of a metastatic lesion. You could check with your physician to see if there is tissue available to send off for a Decipher test. Pathology labs retain the pathology slides and tissue samples.
While some (ok a lot) of this went over my head, this sounds like a really exciting development in the diagnosis and treatment for PCa. I'll have to ask my urologist if it's still possible to get a Decipher test from my prostate that was removed in September 2024. I always appreciate your posts, Keith. Thanks for another fascinating one!
Thanks Steve!
As someone who treats patients with prostate cancer with minimally invasive/focal therapies, I find the DECIPHER data particularly useful primarily for lower grade prostate cancers that can be safely watched but not treated. I am hopeful that further mining of this data will better tell us who DOES NOT need treatment which I believe is a large group of men given this diagnosis every year— the so-called “benign malignancy” group.
I am amazed that many of my seasoned urology colleagues do not believe in this testing and I have received pushback from such colleagues when I advocate this testing for mutual patients. Why?
1) Some say the data does not represent all patient groups due to varying demographics and may be “dated” as it was accumulated many years ago. I do not agree with this given the enormity of the Decipher GRID
2) Some object to the proprietary nature of the database and ability to monetize prognosis at such a large scale (i.e “23 and me” phenomena
Interested in Keith’s thoughts…..Great topic!
Hi Eric. There will always be docs who don't believe in something, mainly because they don't "experiment" with it to honestly understand how it works. Lots of docs are using Decipher Prostate to help decide if active surveillance is indicated or not. I totally agree we need more tools to determine who not to treat. The more I read about the GRID the more I feel it has enormous potential. It's data is mostly Euro-centric and we definitely need more data from trialswith black men. Sadly that's the case across the board with clinical trials for prostate cancer. I'll probably do another post on the GRID because there is some interesting stuff I left off because the post was getting too long. And the report itself is very cool. Thanks for following and commenting.
Less torture, more success. Let's hope the government doesn't defund. I wonder how defunding has already affected knowledge. My prayers and best wishes always through your torturous Journey.
Thank you Thomas!
This is an excellent explainer, and I appreciate how you separate the clinical product (a 22-gene prognostic score) from the platform (the transcriptomic “factory” that keeps learning). That distinction is often missed and it’s where the real future of precision oncology lives. From a clinician’s lens, the promise here isn’t “more data,” it’s better decisions: identifying who truly needs treatment escalation versus who can safely de-escalate. That’s especially important in prostate cancer, where the harms of overtreatment (urinary/sexual side effects, fatigue, financial toxicity) can be profound. The shift you highlight, from prognostic to predictive signatures (therapy selection, radiation dosing, etc.) is exactly the direction we need. I also appreciate your implied caution: research-use outputs can be informative, but they still need rigorous prospective validation, transparent performance across diverse populations, and clear guardrails for how clinicians should (and shouldn’t) act on them. Really valuable post! This is the kind of systems-level thinking that can reduce “torture” and improve outcomes at scale.
Thanks so much. I think Decipher GRID holds incredible potential for true precision oncology.
Thank you for this post. I just received my Decipher report indicating .82 high risk. I have requested that we get the GRID info now also to discern the best path forward.
I'm sorry to hear about your high-risk score, but I hope your doctor is savvy enough to grasp the overriding theme in your GRID report.