Materials and methods

Prostate biopsy specimens diagnosed as prostatic adenocarcinoma between 2024 and 2025 were retrospectively retrieved from the pathology archives. All biopsies consisted of ultrasound-guided systematic core biopsies with a minimum of six cores. Cases were included if Decipher genomic classifier (GC) testing had been performed.

For each case, hematoxylin and eosin (H&E)-stained slides were reviewed by one genitourinary pathologist and a pathology resident in a blinded manner with respect to the Decipher risk group status. Clinicopathologic data was also collected and included patient age, serum PSA level at diagnosis, the Decipher risk group, grade group (GG), positive core ratio (number of positive cores/total number of cores, per case), maximum tumor length ratio (maximum tumor length/specific core length, per case), presence of cribriform architecture, intraductal carcinoma component, necrosis, neuroendocrine differentiation, extraprostatic extension, metastatic status and sites, and patient vital status. Statistical comparisons were performed across Decipher risk groups.

Statistical analyses were conducted using IBM SPSS Statistics version 28.0.1.0 (Armonk, NY, USA). Continuous variables were compared across the three Decipher risk groups using one-way analysis of variance (ANOVA), with post hoc pairwise comparisons performed using Tukey’s honestly significant difference (HSD) test. PSA levels were compared using the Kruskal-Wallis test, as they are non-normally distributed, with post hoc pairwise comparisons performed using Dunn’s analysis. Categorical variables were analyzed using the chi-square test or Fisher’s exact test, as appropriate, depending on expected cell frequencies. Statistical significance was set at p<0.05 for all analyses.

This study was approved by the Institutional Review Board and Ethics Committee of Albert Einstein College of Medicine, Montefiore Medical Center (approval number: 136724).