ENZAMET Trial Shows Veracyte’s Decipher Prostate Test Identifies Which Patients Benefit From Adding Chemotherapy in Metastatic Prostate Cancer

Key Takeaways

• Decipher predicts benefit from adding docetaxel to ADT + enzalutamide.
• High scores (>0.85) improve survival with triplet therapy.
• Low scores show no advantage, enabling chemotherapy avoidance.
• Biomarker interaction significant (p=0.043), delivering Level 1B evidence.
• Decipher refines risk classification for high‑risk localized disease.

Pulse Analysis

Prostate cancer remains the most common malignancy among U.S. men, with roughly 334,000 new diagnoses each year and about 30,000 presenting with metastatic disease at onset. While androgen‑deprivation therapy (ADT) combined with androgen‑receptor pathway inhibitors such as enzalutamide has become standard, the addition of chemotherapy (docetaxel) can further extend survival but also introduces toxicity. Clinicians have lacked a reliable tool to identify which metastatic patients truly benefit from this intensification. The ENZAMET Phase III trial, presented at ASCO 2026, leveraged Veracyte’s Decipher Prostate genomic classifier to fill that gap, delivering the first Level 1B evidence that a molecular test can guide triplet‑therapy decisions.

The pre‑specified biomarker analysis included 634 ENZAMET participants with a median follow‑up of 5.6 years. Patients whose Decipher scores exceeded 0.85 and who harbored high‑volume disease experienced a statistically significant survival advantage when docetaxel was added to ADT + enzalutamide, whereas those with lower scores derived no measurable benefit. The treatment‑by‑biomarker interaction reached p = 0.043, confirming predictive value. By sparing low‑risk patients from unnecessary chemotherapy, the test not only reduces exposure to adverse effects but also conserves health‑care resources, aligning therapeutic intensity with tumor biology.

Beyond metastatic settings, Decipher’s utility extends to high‑risk localized prostate cancer, where combined analyses of four NRG/RTOG trials showed improved prognostic accuracy and reclassification of roughly one‑quarter of patients. For Veracyte, these data broaden the market addressable by its prostate portfolio and reinforce its positioning as a leader in transcriptomic diagnostics across the disease continuum. Payers and providers are likely to view the test as a cost‑effective decision‑support tool, especially as value‑based reimbursement models gain traction. Continued real‑world evidence and integration into clinical guidelines could accelerate adoption, shaping future standards of care for both early‑stage and metastatic prostate cancer.