Decipher Prostate Test for Providers

The Decipher Prostate test measures the expression of 22 genes in prostate cancer tissue to convey tumor aggressiveness and disease progression risk.

How to Order Sample Reports
Cancer area illustration

Most widely-published gene expression test for prostate cancer1

Validated as a highly accurate prognostic tool for distant metastasis, metastatic progression, prostate cancer–specific mortality, and overall survival, as well as other clinically relevant endpoints in prostate cancer.

>300K

Patients tested to date2

>115

Peer-reviewed publications demonstrating the clinical validity and utility of Decipher Prostate3

>25

Ongoing prospective randomized clinical trials that include Decipher Prostate

glowing divider

National Comprehensive Cancer Network® (NCCN®)4

The only gene expression test included in V5.2026 of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Guidelines for Prostate Cancer

“The Panel recognizes that there is an extensive number of advanced tools created with substantial variability in quality of reporting and model design, endpoint selection, and quality and caliber of validation. There are risks in using advanced tools to change management without robust validation, as they may drive patients or providers to inappropriate treatment options. If advanced tools are used, it is recommended to use tests that have robust validation, ideally with high-quality, long-term clinical trial data and across multiple clinical trials.”

“Only advanced tools with high evidence quality are shown in Table 1. Other prognostic tools that are commonly used are described in the Discussion.” PROS-H, 3 of 6

Principles of risk stratification and biomarkers4

Table 1. Advanced Prognostic Tools

Tool: 22-gene genomic classifier (GC) (Decipher)5-7

Intermediate-risk prostate cancer

“NRG/RTOG 0126 phase Ill randomized trial was profiled post-hoc with a prespecified analysis plan. 5 The study demonstrated the independent prognostic effect of GC on biochemical failure, secondary therapy, DM, PCSM, MFS, and OS. Patients receiving RT alone with low GC scores had 10-year DM rates of 4%, compared with 16% for GC high risk. These results suggest that the benefit of short-term ADT in NCCN intermediate-risk prostate cancer is likely to be smaller in patients with low GC scores (≤0.45) than in patients with high GC scores (≥0.60). A breakdown of outcomes between patients with favorable vs. unfavorable intermediate-risk disease was not provided.”

PROS-H, 4 of 6

High-risk & Very-high-risk prostate cancer

“A meta-analysis of three phase III randomized trials (NRG/RTOG 9202, 9413, and 9902) that included patients with high-very-high-risk prostate cancer were profiled post-hoc with a prespecified analysis plan.7 The studv demonstrated the independent prognostic effect of GC on biochemical failure, DM, MFS, PCSM, and OS. Patients with low GC scores had 10-vear DM rates of 6%, compared with 26% for GC high risk. The absolute benefit of LT-ADT over ST-ADT was 11% for patients with high GC scores (NNT of 9), and 3% for patients with low GC scores (NNT of 33). These results suggest that the benefit of long-term ADT in NCCN high- and very-high-risk prostate cancer is likely to be smaller in patients with low GC scores (≤0.45) than in patients with high GC scores (≥0.60). A breakdown of outcomes between patients with high- vs. very high-risk disease was not provided.”

PROS-H, 5 of 6

BCR post-RP

“Two phase Ill randomized trials post-RP were profiled post-hoc with prespecified analysis plans. NRG/RTOG 9601 demonstrated the independent prognostic effect of GC on DM, PCSM, and OS, and found that for patients with lower entry PSAs (<0.7 ng/mL), the 12-year DM rate benefit from hormone therapy for patients with GC lower risk vs. GC higher risk was 0.4% vs. 11.2%.8 The SAKK 09/10 phase Ill trial tested post-RP lower vs. higher dose RT alone. The study demonstrated the independent prognostic effect of GC on biochemical progression, clinical progression, secondary hormone therapy, DM, and MFS.b,9 These results suggest that the benefit of ADT added to RT for patients with RP recurrence planned for early secondary RT is likely to be smaller in those with low or intermediate GC scores (<0.60) than in those with high GC scores.
(≥0.60).”

PROS-H, 5 of 6

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How the Decipher Prostate test works

The test utilizes a genome-wide transcriptome assay to analyze the expression of 22 genes to generate the Decipher score.

  • Performed on existing tissue samples obtained during biopsy or surgical removal of the prostate, prior to any radiation or hormone therapy.
  • Indicated in localized, N1, or metastatic disease.
  • Provides the Decipher score based on genomic characteristics of the tumor, independent of clinical and pathological factors. The score, ranging between 0 and 1, reflects tumor aggressiveness.
    • For localized prostate cancer, Decipher score reflects the risk of metastasis.
    • For metastatic prostate cancer, Decipher score reflects the risk of metastatic progression.
  • The way the test is applied in clinical practice depends on the patient’s scenario and treatment setting.

Localized prostate cancer5-21

decipher risk bar with supporting text around high-risk and low-risk

Metastatic prostate cancer16,22-25

mestastatic decipher risk bar

Decipher Prostate Resources

Sample reports

Post-biopsy sample report

For patients with localized prostate cancer who have not received radiation or hormone therapy before biopsy.

Download Sample Report

Post-radical prostatectomy sample report

For patients with localized prostate cancer after surgery, before radiation or hormone therapy. 

Download Sample Report

Metastatic sample report

For patients with metastatic prostate cancer. The test uses the most recent biopsy or radical prostatectomy sample before starting radiation or hormone therapy. 

Download Sample Report

Informing key clinical decisions across the spectrum of prostate cancer

Post-Biopsy

(Localized Prostate Cancer)

NCCN* RiskClinical DecisionTreatment Considerations
Low & Favorable Intermediate
Active Surveillance Protocol
high:
More Intense Surveillance 11,15-18
medium:
low:
Less Intense Surveillance 11,15-18
Low & Favorable Intermediate
Definitive Therapy or Active Surveillance
high:
Definitive Therapy 11,15-18
medium:
low:
Active Surveillance 11,15-18
Favorable Intermediate & Unfavorable Intermediate
Radiation or Radiation + ADT
high:
Radiation + ADT 10,11,19
medium:
low:
Radiation Alone 10,11,19
Unfavorable Intermediate & High
Duration of Hormone Therapy with Radiation
high:
Long-Term ADT + Radiation 12,20
medium:
low:
Short-Term ADT + Radiation 12,20
High / Very High & Node Positive
Radiation + ADT or Radiation + ADT + Abiraterone
high:
Radiation + ADT + Abiraterone 21
medium:
low:
Radiation ADT 21

ADT = Androgen Deprivation Therapy

Post-Radical Prostatectomy

(Localized Prostate Cancer)

PatientClinical DecisionTreatment Considerations
Post-Radical Prostatectomy (RP)
PSA Monitoring or Treatment
high:
Treatment 13,14,22-25
medium:
low:
PSA Monitoring 13,14,22-25
Post-Radical Prostatectomy with BCR (Salvage Setting)
Radiation Alone or Radiation + ADT
high:
Radiation + ADT 13,14,22-25
medium:
low:
Radiation Alone 13,14,22-25
Post-Radical Prostatectomy with BCR (Salvage Setting)
Radiation + ADT +/- PLNRT
high:
Radiation + ADT + PLNRT 26
medium:
low:
Radiation + ADT 26

ADT: Androgen Deprivation Therapy; PSA: Prostate Specific Antigen; PLNRT: Pelvic Lymph Node Radiation Therapy

Metastatic Prostate Cancer

(Post-Biopsy or Post-RP)

PatientClinical DecisionTreatment Considerations
Metastatic Castration-Sensitive Prostate Cancer (mCSPC)
(Biopsy or Radical Prostatectomy)
Intensification with ARPIs or ARPIs + Chemotherapy
high:
ADT +/– ARPI +/– 
Docetaxel 21,27-30
low:
ADT +/– ARPI 21,27-30

ADT: Androgen Deprivation Therapy; ARPI: Androgen Receptor Pathway Inhibitor

Clinician perspectives

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How to order the Decipher Prostate test

Once the Decipher Prostate test has been ordered by a clinician, Veracyte will request the patient’s tissue.

Documents required to place an order

Online orders

The Decipher portal is an online tool that enables you to place, track order status, and view order results.

Visit our Decipher portal and login.

Request a new Decipher portal account: Please fill out the contact us form and a representative will reach out to you.

Fax and email orders

If your practice does not have a Decipher portal account, you may also send the completed requisition form via email or fax.

[email protected]

+1-858-766 6575

Medicare and insurance coverage for Decipher Prostate

Decipher Prostate is covered by Medicare. It is included in national guidelines and is covered by most major insurance plans across the US. Financial support may be available to eligible patients.

Medicare and Insurance Coverage Patient Financial Assistance

Frequently Asked Questions

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References

  1. Based on data available from commercial websites as of February 17, 2026.
  2. Decipher patients tested from inception through December 31, 2025
  3. Company data on file as of February 17, 2026.
  4. Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer V5.2026. © 2026 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. The NCCN Guidelines are a work in progress that may be refined as often as new significant data becomes available. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way. NCCN = National Comprehensive Cancer Network® (NCCN®).
    a. In the absence of prospective trials, caution is warranted if using these prognostic tools to influence treatment decisions. The Panel awaits future trials that confirm the initial results described here.
    b. SAKK 09/10 combined GC low and intermediate risk due to similar prognosis. NRG/RTOG 9601 dichotomized patients by GC low versus intermediate/high risk; however, due to tissue age (>20 years), GC score shifting is known, and contemporary distributions approximate combining GC low and intermediate risk. Abbreviations: GC = genomic classifier; DM = distant metastasis; PCSM = prostate cancer-specific mortality; MFS = metastasis-free survival; OS = overall survival; RT = radiation therapy; ADT = androgen deprivation therapy; LT-ADT = long-term ADT; ST-ADT = short-term ADT; NNT = number needed to treat; RP = radical prostatectomy; PSA = prostate-specific antigen.
  5. Spratt DE et al., 2023. Int. J. Radiat. Oncol. Biol. Phys. 117, 370-377.
  6. Nguyen PL et al., 2023. Int. J. Radiat. Oncol. Biol. Phys. 116, 521-529.
  7. Spratt DE et al., 2018. J Clin Oncol 36, 581-590.
  8. Feng FY et al., 2021. JAMA Oncol 7, 544-552.
  9. Dal Pra A et al., 2022. Ann Oncol 33, 950-958.
  10. Spratt DE, et al. Int J Radiat Oncol Biol Phys. 2023. DOI: 10.1016/j.ijrobp.2023.04.010
  11. Spratt DE, et al. J Clin Oncol. 2018. DOI: 10.1200/jco.2017.74.2940
  12. Nguyen PL, et al. Int J Radiat Oncol Biol Phys. 2023. DOI: 10.1016/j.ijrobp.2022.12.035
  13. Feng FY, et al. JAMA Oncol. 2021. DOI: 10.1001/jamaoncol.2020.7671
  14. Dal Pra A, et al. Ann Oncol. 2022. DOI: 10.1016/j.annonc.2022.05.007
  15. Zhu A, et al. Eur Urol Oncol. 2024. DOI: 10.1016/j.euo.2024.06.007
  16. Vince RA Jr, et al. Prostate Cancer Prostatic Dis. 2022. DOI: 10.1038/s41391-021-00428-y
  17. Kim HL, et al. Prostate Cancer Prostatic Dis. 2019. DOI: 10.1038/s41391-018-0101-6
  18. Herlemann A, et al. Prostate Cancer Prostatic Dis. 2020. DOI: 10.1038/s41391-019-0167-9
  19. Berlin A, et al. Int J Radiat Oncol Biol Phys. 2019. DOI: 10.1016/j.ijrobp.2018.08.030
  20. Nguyen PL, et al. Prostate Cancer Prostatic Dis. 2017. DOI: 10.1038/pcan.2016.58
  21. Parry M, et al. Ann Oncol. 2022. DOI: 10.1016/j.annonc.2022.07.1491
  22. Den RB, et al. J Clin Oncol. 2015. DOI: 10.1200/jco.2014.59.0026
  23. Ross AE, et al. Prostate Cancer Prostatic Dis. 2016. DOI: 10.1038/pcan.2016.15
  24. Marascio J, et al. Prostate Cancer Prostatic Dis. 2020. DOI: 10.1038/s41391-019-0185-7
  25. Spratt DE, et al. Eur Urol. 2018. DOI: 10.1016/j.eururo.2017.11.024
  26. Pollack A, et al. J Clin Oncol. 2025. DOI: 10.1200/JCO.2025.43.5_suppl.399
  27. Feng FY, et al. J Clin Oncol. 2020. DOI: 10.1200/JCO.2020.38.15_suppl.5535
  28. Feng FY, et al. JAMA Oncol. 2021. DOI: 10.1001/jamaoncol.2021.1463
  29. Hamid AA, et al. Ann Oncol. 2021. DOI: 10.1016/j.annonc.2021.06.003
  30. Grist E, et al. Ann Oncol. 2024. DOI: 10.1016/j.annonc.2024.08.1677

Disclaimers

Decipher testing is available in the United States as part of Veracyte’s CLIA-validated laboratory developed test (LDT) service, and FDA clearance is not required.

Talk to your doctor about whether Veracyte tests might be right for you.

All recommendations are category 2A unless otherwise indicated. “Category 2A” is derived from the National Comprehensive Cancer Network® (NCCN®) Categories of Evidence and Consensus (CAT-1), which is independent from the Simon levels of evidence1 used to warrant inclusion in Table 1 above. The category 2A footnote above applies to recommendations only, and means that, based upon lower-level evidence, there is uniform NCCN consensus (≥85% support of the Panel) that the intervention is appropriate. Simon Level II evidence pertains to the nature and level of clinical trial evidence, and includes only levels IIB and IIC, as there is no Simon Level IIA.1

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