A molecular diagnostic test could help doctors identify which men with high-risk prostate cancer would benefit most from additional hormone treatment, potentially sparing others from unnecessary treatment and its side effects, according to new research from University College London (UCL).

The findings, due to be presented at the European Society for Medical Oncology Congress 2026 in Madrid tomorrow (24 October), suggest the Decipher genomic test could help personalise treatment for men whose cancer has not spread to distant parts of the body.

Researchers analysed Decipher scores from two datasets: real-world data covering 27,607 men, including 5,956 assessed for outcomes, and 401 men with non-metastatic prostate cancer who took part in the STAMPEDE abiraterone clinical trial.

They found that higher Decipher scores consistently predicted poorer outcomes. For every 0.1 increase in the score, the risk of cancer spreading to distant parts of the body increased, while the risk of dying from prostate cancer also rose.

The test also helped identify men whose cancer had not spread to their lymph nodes who could benefit from adding abiraterone to standard treatment to reduce the risk of distant spread.

Previous findings from the STAMPEDE trial showed that adding abiraterone to standard treatment for men with high-risk, localised prostate cancer could halve their risk of dying from the disease and slow its progression. However, additional hormone treatment can cause side effects, including fatigue, and its benefits may vary between patients.

Dr Sarah Howlett, the study's lead researcher at the UCL Cancer Institute, 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.

'Showing the same pattern in both a large real-world dataset and a randomised clinical trial strengthens the findings. But further validation in other datasets is needed before the test is used routinely to make these decisions.'

Prostate cancer is the most common cancer in men, and doctors face a challenge in balancing the benefits of more intensive treatment against its potential impact on patients' quality of life.

In January, NHS England announced plans to roll out abiraterone for men in England with high-risk, locally advanced prostate cancer. Patients with similar risk profiles in Wales and Scotland already had NHS access to the drug.

The research could provide a further step towards tailoring treatment to individual patients, helping doctors weigh the potential benefits of additional therapy against its risks.

Elai Davicioni, medical director, Urology for US cancer diagnostics firm Veracyte, which makes the Decipher test, said: '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.

'These findings expand Decipher's predictive evidence to another consequential treatment decision: whether adding abiraterone will provide meaningful benefit for a man with very high-risk prostate cancer.'