Genomic Risk Classifiers: Similar, but Not the Same

by Kiernan Mehan | Oct 28, 2025 | Active Surveillance PCa, Low/Intermediate Prostate Cancer, Prostate Cancer

Genomic Risk Classifiers: Similar, but Not the Same

Genomic Risk Classifiers, or GRCs, are lab tests performed on prostate biopsy or surgical tissue to estimate how aggressive your specific cancer may be. A relatively recent addition to prostate cancer care, their use has grown from virtually none to nearly one in five diagnosed cases over the past decade. The three most common tests are Decipher, Prolaris, and Oncotype DX Genomic Prostate Score (GPS).

These tests don’t replace standard measures such as Gleason score, PSA, or imaging results, but they give doctors an additional layer of information to help guide treatment planning. Depending on the result, a GRC may influence key decisions such as whether active surveillance is appropriate, whether to add hormone therapy (ADT) to radiation, or whether to recommend post-surgery radiation.

Although the tests share a similar goal—to clarify how risky a given cancer might be—they analyze different sets of genes and use different scoring systems. There’s currently no universal standard for comparing one test to another, and few long-term studies show whether using them improves survival or quality of life. Still, real-world data offer some interesting insights.

Patients who received Prolaris testing were the most likely to go on to surgery. Those who had Decipher were more likely to receive radiation combined with hormone therapy. Men who had Oncotype DX were the most likely to choose active surveillance. Overall, men who underwent any GRC test were about twice as likely to select active surveillance rather than immediate radical treatment. Among those who did pursue treatment, GRC-tested patients tended to choose radiation more often than surgery.

GRC results are also beginning to shape decisions about focal therapy, an approach that targets only part of the prostate. Studies suggest that men with higher genomic risk scores are less likely to be good candidates for this type of limited treatment because of higher recurrence rates.

Despite their promise, GRCs have limitations. They can be expensive, and insurance coverage is inconsistent. Because each test measures different biological features, results can occasionally conflict or add uncertainty rather than resolve it. And while the tests can better predict the likelihood of progression, they don’t guarantee what will happen in any individual case.

The takeaway:
GRCs are useful tools that can help tailor prostate cancer care more precisely to your situation. But they should be viewed as one piece of the puzzle—complementing, not replacing, established clinical factors and your doctor’s judgment. Used wisely, they can support more confident, individualized treatment choices.

-Stuart Jordan

For more information or questions, please contact stuart@ancan.org.

Cancer Patient Lab: Beyond Single-Gene Mutations: Using Polygenic Risk Scores to Improve Cancer Prevention

Wednesday, October 29th @ Noon Eastern with Giordano Botta, PhD. Polygenic Risk Scores (PRS) are tests familiar to many diagnosed with prostate cancer that allow you to assess the aggressiveness of your disease. Perhaps more familiar as Decipher, Prolaris, or Oncotype Dx, they are becoming standard tools for risk assessment.

Join the event directly here.