A molecular diagnostic test could help doctors determine which men with high risk prostate cancer need stronger treatment and which patients may be able to avoid unnecessary medication and difficult side effects.

Researchers at University College London analyzed Decipher, a tissue based molecular test, to evaluate whether it could identify patients most likely to benefit from more intensive therapy. The findings point toward a more personalized approach to prostate cancer care.

The analysis focused on abiraterone, a hormone therapy examined in the STAMPEDE clinical trial. That trial found that adding abiraterone to standard treatment could cut the risk of death in half among men with high risk, localized prostate cancer.

Researchers presented the findings at the European Society for Medical Oncology Congress 2026 in Madrid. The event was held from Oct. 23 through Oct. 27.

Not every prostate cancer behaves in the same way, and aggressive treatment can carry substantial costs for patients. A University College London news release warned that treating someone more intensively than necessary could lead to “increased side effects and poorer quality of life.”

Because prostate cancers can differ at the molecular level, adding hormone therapy does not benefit every patient equally. Researchers examined whether Decipher scores could help doctors distinguish between men who may need additional treatment and those who may not.

The team studied Decipher test scores from more than 27,000 patients represented in real world data. Researchers also analyzed 401 men with prostate cancer that had not metastasized who participated in the STAMPEDE abiraterone trial.

Higher Decipher scores predicted worse outcomes, indicating that the cancer was more likely to spread and that additional treatment might be valuable. Lower scores suggested that a patient could face less risk of spread and might not require more intensive therapy.

Lead researcher Dr. Sarah Howlett of UCL Cancer Institute said preventing the disease from spreading is “critical” for men with very high risk prostate cancer. “Understanding who benefits most from additional treatment can make a meaningful difference,” she added.

The results suggest that men with high risk prostate cancer and low Decipher scores may be able to avoid more intensive treatment. Those with high scores may be the strongest candidates for adding therapy to their standard care.

Howlett noted that researchers identified the same general pattern in both the large real world dataset and the randomized clinical trial. Finding consistent results across those two sources strengthened the research, although she cautioned against immediately adopting the test for routine treatment decisions.

“But further validation in other datasets is needed before the test is used routinely to make these decisions,” Howlett said. Her warning reflects the need for more evidence before Decipher becomes a standard tool for determining who receives additional therapy.

Elai Davicioni, medical director of urology for Decipher test maker Veracyte, said the accumulating research could help physicians weigh treatment benefits against quality of life concerns. “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.”

Fox News senior medical analyst Dr. Marc Siegel, who was not involved in the study, emphasized the differences among individual cases. “Prostate cancer varies from person to person,” he said. “Medical science is increasingly aware that it is not one size fits all.”

Siegel said localized prostate cancer may contain mutations that predict how aggressive the disease will become and whether it could respond to targeted therapies. Certain targeted treatments are increasingly used for widespread prostate cancer, including “more powerful anti-androgens, which works not just on the testes, but on the adrenals as well.”

Hormone therapies can have “significant side effects,” including fatigue, and “don’t always help,” Siegel added. He said the study benefited from combining a randomized treatment group with Decipher testing to identify patients most likely to respond to intensive hormone therapy.

“This is the personalized, precise approach of the near future,” Siegel said. Prostate cancer is the second leading cause of cancer death behind lung cancer, and about one in eight American men will receive a prostate cancer diagnosis during his lifetime, according to the American Cancer Society.