Genomics of Tumor Biology
Decipher Prostate is a genomic classifier (GC) test to screen patients for prostate cancer and provides an independent prediction of early clinical metastasis and Prostate Cancer-Specific Mortality following biopsy or radical prostatectomy (RP)38, 39, 40, 41. Decipher was created by compiling the genes of 192 metastatic patients with increasing PSA levels over 5 years and comparing them with 271 patients from a retrospective, nested case-control study, culminating in a 22 gene marker signature, known as the Decipher GC42. Decipher GC includes the expression profiles of coding and non-coding RNA (ncRNA) which is important because genes involved in metastatic disease progression are significantly affected by ncRNAs. Other PCa screeners that do not establish ncRNA may lose the sensitivity to report prognostic information present in GC14. Patient RNA can be extracted from primary prostate cancer specimens that are fixed with formalin and paraffin. After analysis, a Decipher score between 0 and 1 is generated, with low scores of 0.0-0.44, average scores of 0.45-0.59, and high scores of 0.60-1.0. Higher scores indicate an increased likelihood of adverse pathological outcomes41 43. In particular, patients with lower GC scores tend to have lower incidence of metastasis while higher GC scores give a prognosis of increased metastasis39. The clinical utility of Decipher has been verified specifically in intermediate and advanced PCa patients44. Further validation is needed to verify the disparity between PCa screening of AAM and EAM using Decipher GC.