Genomic Test Identifies African Americans at Risk for Early Prostate Cancer Recurrence

African American men face a disproportionately higher incidence and mortality risk, yet have historically been underrepresented in genomic studies that guide treatment decisions. Existing clinical tools do not always capture the biological differences that drive early recurrence after treatment. New evidence now shows that a widely used genomic test can more accurately identify men at high risk for rapid prostate cancer recurrence, with especially strong predictive value in African American patients.

A study by investigators at Moffitt Cancer Center (Tampa, FL, USA evaluated the performance of the Decipher genomic classifier, a test designed to reveal tumor biology beyond standard clinical factors such as PSA levels, Gleason score, and imaging. The goal was to assess whether this genomic tool reliably predicts early recurrence in African American men treated in real-world clinical settings.

The VANDAAM study enrolled 243 men with early-stage prostate cancer treated between 2016 and 2021, with equal representation of African American and white patients who had similar clinical risk at diagnosis. All participants underwent Decipher testing on biopsy tissue prior to treatment and were followed for approximately two years after surgery or radiotherapy. Regular PSA monitoring was used to detect early biochemical recurrence.

Among 207 men with complete follow-up, those with high Decipher genomic-risk scores were nearly five times more likely to experience PSA recurrence within two years than those with low-risk scores. The association was particularly strong in African American men, where a high genomic-risk score was linked to roughly 17-fold higher odds of early recurrence, and all observed recurrences occurred in the high-risk group.

The findings, published in the Journal of the National Comprehensive Cancer Network, show that combining genomic risk information with standard clinical factors improves early recurrence prediction across treatment types and racial groups. The study also suggests that biopsy-based genomic testing often provides reliable guidance before treatment decisions are made. Larger and more diverse cohorts will be needed to validate long-term outcomes, but the findings support earlier use of genomic testing to guide personalized treatment and reduce disparities in prostate cancer care.

“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. “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.”

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Moffitt Cancer Center