Genomic Classifier Validates Early Prostate Cancer Recurrence Risk in African American Men, VA Study Finds

Key Clinical Summary

• Prospective validation: A genomic classifier (Decipher) independently predicted rapid 2-year biochemical recurrence in African American men with localized prostate cancer.
• Magnitude of risk: High genomic risk was associated with a more than 5-fold increase in odds of early recurrence.
• Clinical relevance: Findings support integrating genomic testing to improve risk stratification and reduce disparities in prostate cancer care for US veterans.

Precision oncology has improved prostate cancer risk stratification, but limited inclusion of African American men has raised concerns about equity and generalizability. A new prospective, multicenter validation study provides evidence that a widely used genomic classifier can predict early biochemical recurrence in African American men with low- or intermediate-risk prostate cancer, offering clinically actionable insights for physicians caring for US military veterans.

Study Findings

The prospective validation study approved by the Institutional Review Board of Moffitt Cancer Center and Research Institute, James A. Haley Veterans’ Hospital, and Bay Pines Veterans Affairs Healthcare System, enrolled patients between 2016 and 2021 across multiple centers. Investigators recruited 243 men with low- or intermediate-risk prostate cancer in a 1:1 ratio of African American men and White men, matched by Cancer of the Prostate Risk Assessment (CAPRA) score. Patients who chose active surveillance were excluded.

Decipher genomic classifier testing, a 22-marker assay estimating metastatic risk, was performed on biopsy and/or radical prostatectomy tissue. The primary endpoint was the ability of the genomic classifier to predict 2-year biochemical recurrence (BCR), used as a surrogate for aggressive disease.

The final analytic cohort included 226 matched patients with genomic data and 207 evaluable cases with complete outcomes (104 African American men and 103 White men). Overall, patients with a high genomic-risk score had 5.25-fold increased odds of rapid-onset 2-year BCR compared with those with low-risk scores (odds ratio, 5.25; 95% CI, 1.27-21.66; P = .021).

In a surgical subset of 74 patients, concordance between biopsy-derived and radical prostatectomy–derived genomic risk categories was 77%, defined as no change in risk classification. Investigators implemented standardized prostate-specific antigen (PSA) surveillance schedules and adjusted analyses for treatment modality and clinicopathologic variables, including age, race, PSA, Gleason score, and tumor burden.

Despite the relatively small number of recurrence events (n = 15), the genomic classifier remained an independent predictor of early recurrence across racial subgroups.

Clinical Implications

Prostate cancer disproportionately affects African American men, including US military veterans, who often present with more aggressive disease. This study demonstrates that genomic classifiers can be prospectively validated in racially diverse cohorts and used to identify aggressive disease earlier in the treatment pathway.

For clinicians treating veterans, these findings suggest that incorporating genomic risk assessment at diagnosis may refine decisions regarding surgery, radiation, or treatment intensification. The ability of biopsy-derived genomic scores to predict early recurrence supports use before definitive therapy, when treatment choices have the greatest long-term impact.

Importantly, the study addresses a critical gap in evidence by validating genomic testing in a population historically underrepresented in precision oncology trials. While limitations include sample size and short follow-up, the results support broader adoption of genomic classifiers to help mitigate disparities rather than exacerbate them.

According to the study authors, this trial “represents the first prospective validation of genomic classifier performance in predicting early 2-year biochemical recurrence in both African American and White men.” They concluded that the classifier “is an independent predictor of early 2-year biochemical recurrence in African American men” and can be integrated into clinical practice to improve risk stratification and management of early-stage prostate cancer.

Conclusion

This prospective validation provides evidence that genomic classifiers can reliably predict early prostate cancer recurrence in African American men. For clinicians caring for US veterans, integrating genomic testing may enhance personalized treatment decisions and support more equitable prostate cancer care.

Reference

Yamoah K, Trivedi P, Awasthi S, et al. A prospective validation of the decipher genomic classifier in men with early localized prostate cancer: the VANDAAM study. J Natl Compr Canc Netw. Dec;2025. https://doi.org/10.6004/jnccn.2025.7089