A new Moffitt Cancer Center study suggests a widely used genomic test can more accurately identify which men with early prostate cancer are at high risk for their disease to come back quickly after treatment, particularly African American men who face the highest burden from this disease. The findings were published in the Journal of the National Comprehensive Cancer Network.
Prostate cancer is the second most diagnosed cancer in men worldwide and a leading cause of cancer death in the United States. African American men have about a 73% higher incidence of prostate cancer and a 23% higher mortality rate than white men, yet they have been underrepresented in genomic research that informs treatment guidelines.
Genomic risk tests, such as the Decipher classifier, can reveal hidden tumor biology beyond PSA level, Gleason score and imaging findings. Until now, however, there has been limited prospective evidence that these tests perform reliably in African American men with localized disease who are treated in real-world settings.
Inside the VANDAAM Study
The VANDAAM study enrolled 243 men with early stage prostate cancer treated at Moffitt, James A. Haley Veterans' Hospital or Bay Pines VA Healthcare System between 2016 and 2021, with equal numbers of African American and white participants who had similar clinical risk at diagnosis. All men had the Decipher genomic test on their biopsy tissue prior to treatment and, when available, on prostate tissue removed during surgery, and were then followed for about two years to watch for early signs that the cancer was coming back.
For the main analysis, researchers focused on 207 men who had complete test results and follow-up, including 104 African American men and 103 white men. Everyone received treatment with either surgery or definitive radiotherapy with or without short-term hormone therapy according to standard-of-care guidelines and had regular PSA blood tests for two years after treatment to check for a rise that could signal the cancer's return.
Key Findings on Early Recurrence Risk
When the team looked at all 207 men together, those with a high genomic-risk Decipher score were about five times more likely to have their PSA rise again within two years than those with a low-risk score, even after considering age, PSA, Gleason score and other clinical details. Among African American men, the signal was especially strong because a high genomic-risk score was linked to roughly 17 times higher odds of early recurrence, and every African American man who had a recurrence was in the high genomic-risk group.
By combining the genomic scores with routine clinical information for African American men, the researchers were able to accurately separate those whose cancer came back within two years from those who stayed recurrence free. The link between a high genomic-risk score and early recurrence looked similar in both African American and white men and in men treated with either surgery or definitive radiotherapy.
"One of the most important messages from this study is that genomic risk information adds useful detail on top of the tools clinicians already use," said Kosj Yamoah, MD, PhD , principal investigator of the study and chair of the Radiation Oncology Department at Moffitt. "For African American men with early prostate cancer, this test helped separate a small group with rapid recurrence from the large group who remained cancer free at two years."
Implications for Treatment Decisions and Equity
The study also showed that in about three out of four men who had the Decipher test on both their biopsy and their prostate tissue removed during surgery, the risk category was the same, suggesting that testing the biopsy alone can often give reliable guidance before treatment decisions are made. In men whose tumors were labeled as having a higher genomic risk after surgery, cancers in the front part of the prostate were more likely to be upgraded, pointing to areas that routine biopsies may not fully capture.
A smaller group of African American tumors had a distinctive genomic pattern with more immune activity and lower levels of DNA repair signals, which may help explain why some African American patients do particularly well with radiotherapy in this and other studies.
"These data support using genomic testing earlier in care to better match African American patients with the treatment intensity and type that fit the biology of their tumor," Yamoah said. "It is one practical step toward narrowing long-standing differences in prostate cancer outcomes."
Next Steps and Need for Larger Cohorts
Because only 15 men had their cancer come back during the two-year follow-up, the researchers note that larger studies with more participants from different racial and ethnic backgrounds will help sharpen these risk estimates and track longer-term outcomes, such as the spread of cancer and survival. The investigators suggest that Decipher genomic testing can already be used as part of routine risk assessment to help doctors identify African American men with early localized prostate cancer who may need closer follow-up or more intensive treatment.
This work was supported by the National Institutes of Health (P30-CA076292 and P20-CA233255), the Prostate Cancer Foundation and the George Edgecomb Society.
About Moffitt Cancer Center
Moffitt is dedicated to one lifesaving mission: to contribute to the prevention and cure of cancer. The Tampa-based facility is one of only 58 National Cancer Institute-designated Comprehensive Cancer Centers , a distinction that recognizes Moffitt's scientific excellence, multidisciplinary research, and robust training and education. Moffitt's expert nursing staff is recognized by the American Nurses Credentialing Center with Magnet®
