Understanding Your Decipher Score
What Is the Decipher Score?
The Decipher score is a genomic test that analyzes the genetic activity of your prostate cancer cells to predict how likely the cancer is to spread (metastasize) within 5 years of diagnosis or surgery.
Unlike the Gleason score, which describes how cancer cells look under a microscope, the Decipher score looks at the underlying biology — specifically, the activity of 22 genes within the tumor. This provides an additional layer of information about how the cancer is likely to behave.
How Is the Decipher Score Calculated?
The Decipher test is performed on tissue from your biopsy or from the prostate removed during surgery. The laboratory measures the expression levels of 22 specific genes and uses an algorithm to generate a score between 0 and 1.
A lower score suggests the cancer is less likely to spread. A higher score suggests a greater risk of metastasis.
Interpreting Your Decipher Score
| Decipher Score | Risk Category | Interpretation |
|---|---|---|
| 0.00 – 0.45 | Low | Lower genomic risk of metastasis |
| 0.46 – 0.60 | Intermediate | Moderate genomic risk |
| 0.61 – 1.00 | High | Higher genomic risk of metastasis |
Score thresholds may vary slightly by clinical context and the version of the test used. Your report will include the specific interpretation.
The Decipher test is most commonly ordered for men with intermediate- or high-risk prostate cancer, or after surgery when there is concern about recurrence. Your urologist or oncologist will determine whether it is appropriate for your situation.
When Is the Decipher Test Ordered?
The Decipher test may be ordered in several situations:
- At the time of diagnosis, to help decide between active surveillance and treatment for intermediate-risk cancer.
- After radical prostatectomy (surgery), to assess the risk of recurrence and guide decisions about adjuvant radiation therapy.
- When PSA rises after treatment (biochemical recurrence), to help determine the urgency and type of salvage treatment.
Not every patient needs a Decipher test. It is most useful when standard clinical information (PSA, Gleason score, stage) leaves uncertainty about the best course of action.
What the Decipher Score Does Not Tell You
The Decipher score predicts the probability of metastasis — it does not guarantee an outcome. A high Decipher score does not mean your cancer will definitely spread, and a low score does not guarantee it will not.
It is one piece of a larger puzzle. Your care team will use it alongside your PSA, Gleason score, stage, and other clinical factors to make treatment recommendations.
If you have intermediate- or high-risk prostate cancer and are uncertain about treatment intensity, ask your urologist: 'Would a Decipher test help clarify my treatment decision?' It may provide valuable additional guidance.
A Decipher score—especially one in the high-risk range—can be frightening to see on your report. Remember that Decipher estimates risk; it does not predict your individual future with certainty.
A high score does not mean that your cancer has already spread, and it does not mean that metastasis is inevitable. It tells your healthcare team that the biology of the cancer may deserve closer attention when they consider treatment and follow-up.
Your Decipher result should be interpreted together with your PSA, Gleason score/Grade Group, stage, imaging, pathology findings, overall health, and treatment history.
Instead of focusing on the number alone, ask your doctor:
"What does my Decipher score mean for me, given everything else we know about my cancer?"
That conversation is far more useful than trying to interpret the score by itself.