Evaluation of Decipher (a 22-gene genomic classifier) shows that this biomarker panel independently predicts metastasis in patients with prostate cancer and PSA ≥ 0.1 ng/ml after prostatectomy. In these men, the 5-year metastasis rate was significantly higher in those with genomic high risk according to Decipher than in those with genomic low or intermediate risk (P < 0.001). In multivariate analysis, Decipher high risk was the only independent predictor of metastases (HR 5.61, 95% CI 1.48–22.7; P = 0.01)