‘We May Be Over-Treating Some Patients’: Genetic Test That Reads 22 Genes Inside a Tumour Could Help Decide Which Men With Deadly Prostate Cancer Need a Drug That Halves Their Risk of Dying
- A tumour-analysing test called Decipher could tell doctors which men with high-risk prostate cancer most need intensive hormone therapy, and which can safely skip it.
- Each 0.1 rise in a patient’s Decipher score was linked to a 49 per cent higher risk of the cancer spreading to distant organs and a 38 per cent higher risk of dying from it.
- Abiraterone, the testosterone-blocking drug at the centre of the research, can cut the risk of death by half, but can also cause fatigue, liver damage and urinary tract infections.
- The findings raise questions about how quickly Australian men could gain access to personalised prostate cancer care.
For a man told he has aggressive prostate cancer, the next decision can shape the rest of his life.
Does he take a powerful drug that might save him, along with side-effects that could drain his energy, damage his liver and leave him battling infections?
Or is he one of the men for whom that extra treatment does almost nothing?
Until now, doctors have had no dependable way to tell. A major international study suggests that may be about to change, and the implications reach far beyond Britain.
Researchers at University College London have found that a genomic test, which examines tumour tissue already removed during a biopsy or surgery, can sort high-risk patients into those most likely to benefit from abiraterone and those who could potentially be spared it.
The work, drawn from the long-running STAMPEDE trial, was presented at the European Society for Medical Oncology Congress in Madrid. It drew on data from more than 30,000 men.
The test, known as Decipher and made by US company Veracyte, measures the activity of 22 genes inside a tumour. Each patient is given a score between zero and one.
The higher the number, the greater the danger that the cancer will spread or come back after treatment.
The results were stark.
Every 0.1 increase on that scale carried a 49 per cent higher risk of the disease reaching distant organs, and a 38 per cent higher chance of the man dying from prostate cancer.
Crucially, no additional needles, scans or operations are needed. The analysis uses tissue that has already been collected.
Lead author Dr Sarah Howlett told the Daily Mail that while abiraterone saves lives, some patients may currently be receiving it unnecessarily.
She said the test could show which men need the treatment most, which could avoid it, and which face the highest risk of their cancer returning.
She added that men with high-risk disease but a low Decipher score had low rates of cancer spread and might be spared more intensive treatment, while those with high scores could be put at the front of the queue.
Dr Howlett stressed, however, that larger studies are still required before the test is used routinely to guide treatment.
Veracyte’s medical director, Elai Davicioni, said the company believed the mounting evidence gave doctors a stronger case for using Decipher before making decisions that affect both survival and quality of life.
The breakthrough lands at a pivotal moment. Abiraterone works by shutting down the body’s production of testosterone, the hormone that fuels many prostate tumours.
Earlier research showed that adding it to standard care for men with high-risk disease could cut their risk of death in half.
That evidence led to the drug’s adoption in Wales and Scotland, followed by a rollout on the NHS in England earlier this year. In the UK, around 64,000 men are diagnosed with prostate cancer annually, making it the most common cancer among men there.
But a blanket approach brings a hidden cost. A drug that dramatically helps some men can leave others enduring exhaustion, liver problems and recurring urinary infections for little or no gain.
Medicine has been moving steadily away from one-size-fits-all cancer treatment, and prostate cancer has lagged behind breast cancer, where genomic tumour testing is already an established part of decision-making.
The Daily Mail is campaigning to end needless prostate cancer deaths and supports screening for men at high risk of the disease.
Analysis: What This Means for Australia
Prostate cancer is the most commonly diagnosed cancer among Australian men, with figures tracked by Australian Institute of Health and Welfare and Cancer Australia showing tens of thousands of new cases every year and thousands of deaths.
That makes this research directly relevant to families from Perth to Townsville. Any tool that sharpens treatment decisions could affect a very large number of Australian men and their partners.
The first issue is access. Abiraterone is subsidised under the Pharmaceutical Benefits Scheme for certain stages of advanced prostate cancer, but eligibility rules are specific and change over time.
Genomic tests such as Decipher are generally not part of routine publicly funded care, meaning cost can become a barrier.
A test that guides treatment only for those who can afford it risks widening the gap between wealthier city patients and those in regional and rural areas, where prostate cancer outcomes are already poorer.
The second issue is money.
Targeting expensive drugs at men who genuinely benefit, and sparing those who do not, could ease pressure on a health budget already strained by an ageing population and the broader cost of living squeeze on households.
The third is the human toll. Side-effects such as fatigue and liver damage can force men out of work, strain relationships and hit small towns that depend on older workers.
Avoiding unnecessary treatment is not a luxury. For many families, it is about income and dignity.
Finally, the findings feed into the ongoing national debate about cancer screening and men’s health, including calls from groups such as the Prostate Cancer Foundation of Australia for earlier detection and fairer access to care.
Oncology observers say the study adds weight to a shift already under way: cancer care decided by tumour biology rather than broad risk categories alone.
Health economists believe genomic testing could prove cost-effective if it prevents even a portion of unnecessary prescriptions, though they caution that Australian regulators will want local evidence before committing public funds.
Patient advocates warn that hope must be tempered with patience. The researchers themselves say larger studies are needed, and men currently on treatment should not stop or change medication without speaking to their specialist.
Others in the sector point out the commercial interest at play, noting that the test’s manufacturer naturally has a stake in wider uptake. Independent validation, they say, will be essential.
Still, for the many men who will hear the words ‘high-risk prostate cancer’ this year, the prospect is a powerful one: a simple score, drawn from tissue already taken, that could help answer the most important question they face.