Introduction: Decipher genomic classification (DGC) has been developed to predict disease severity in prostate cancer. This study seeks to evaluate how well Decipher scores predicted actual clinical outcome in 192 patients that underwent robotic prostatectomy (RALRP) with 8-year follow-up of survival outcomes. Methods: Data is collected from an IRB-approved, prospectively-maintained database of 192 patients who underwent RALRP with DGC testing of the post prostatectomy specimens with mean 8 year follow-up outcomes. The Decipher prediction signatures were Metastasis Risk, Androgen Deprivation Therapy (ADT) Response, Post-Operative Radiation Response, Docetaxel Sensitivity, Seminal Vesicle Invasion, Genomic Gleason Score of Primary 4 or 5, Genomic CAPRA-S Score of High (>5), Pathology Stage T3 (pT3 Disease), Tumor Cell Proliferation, and Androgen Receptor (AR) Signaling Activity. A logistic regression analysis test evaluated these signatures with the actual clinical outcomes of metastatic castration-resistant prostate cancer (mCRPC), metastasis, ADT use, overall mortality (OM), and disease-specific mortality (DSM). Results: Higher Decipher scores for pT3 Disease was the most significant predictor of requiring ADT. The odds of ADT were 1.8 times greater for every 25-unit increase in pT3 Disease (95%CI 1.84-4.96, p<0.001). A negative relationship was seen between the Decipher prediction of Genomic Gleason Score of Primary 4 or 5 and no disease progression. The odds of no progression was 0.6 times lower for every 25-unit increase in Genomic Gleason Score of Primary 4 or 5 (95%CI 0.41-0.82, p=0.002). Higher Decipher scores for Post-Operative Radiation Response had a positive relationship with overall mortality. For every 25-unit increase in Post-Operative Radiation Response, OM was 1.9 times greater (95%CI 1.32-2.87, p<0.001). Finally, AR Signaling Activity had a negative relationship with disease-specific mortality. DSM was 0.21 times lower for every 25-unit increase in AR Signaling Activity (95% CI 0.05-0.85, p=0.028). Conclusions: This paper finds correlation between Decipher genomic predictions with actual clinical outcomes at 8 year post prostatectomy follow-up. Decipher scores for pT3 Disease and Genomic Gleason Score of Primary 4 or 5 signature were the best predictors of requiring ADT treatment and of no disease progression, respectively. AR Signaling Activity signature was the best predictor of disease-specific mortality, whereas Post-Operative Radiation Response was the best predictor of overall mortality. SOURCE OF Funding: none
.jpg "Robert Ira Carey, MD photo")