Conclusions

This study indicates that the established histopathologic markers of tumor burden and aggressiveness in diagnostic prostate biopsy specimens significantly correlate with Decipher genomic classifier risk groups. Specifically, higher genomic risk scores were associated with advanced grade groups, increased positive core ratios, and notably longer maximum tumor length ratios. While traditional clinicopathologic variables remain foundational to risk stratification, our findings highlight the ability of genomic profiling to identify high-risk biological phenotypes that may not be fully captured by morphology alone, as evidenced by the presence of high-risk genomic scores in lower-grade specimens.

Furthermore, the exclusive presence of extraprostatic extension and intraductal carcinoma within the high-risk group suggests these features may serve as valuable morphological indicators of a high-risk genomic profile. In conclusion, the integration of Decipher testing into routine clinical practice provides a more nuanced understanding of tumor biology at the time of biopsy, potentially allowing for more personalized treatment pathways and better identification of patients who may benefit from intensified therapy versus those suitable for active surveillance.