Association of Histopathologic Characteristics in Diagnostic Prostate Biopsies With Decipher Genomic Classifier Risk Groups

Prostate cancer remains the most frequently diagnosed malignancy in men. While traditional clinicopathologic parameters guide management, genomic classifiers such as the Decipher assay are increasingly used to refine risk stratification. In this study, we evaluated the association between Decipher genomic classifier (GC) (GenomeDx Biosciences, Vancouver, BC, Canada) risk groups and histopathologic features in diagnostic prostate biopsy specimens within a routine clinical setting. We retrospectively reviewed 73 prostatic adenocarcinoma biopsies that underwent Decipher genomic testing, sampled between 2024 and 2025. Decipher risk groups demonstrated a significant association with grade groups (GG) (p=0.03 (χ²=16.6)), with high-risk (HR) cases showing a higher prevalence of higher GG compared to low-risk (LR) cases. Quantitative metrics of tumor burden were also significantly associated with risk groups: the mean positive core ratio (LR: 0.44 versus HR: 0.64; p=0.003) and mean maximum tumor length ratio (LR: 0.47 versus HR: 0.67; p=0.01) were significantly higher in the HR group. Aggressive features such as extraprostatic extension and intraductal carcinoma were identified exclusively in the HR group. No significant differences were observed for prostate-specific antigen (PSA) levels across groups. In conclusion, histopathologic indicators of tumor aggressiveness and burden in diagnostic prostate biopsies show significant association with Decipher GC risk groups, supporting their complementary role in risk stratification.