Herlemann A, Huang HC, Alam R, et al. - A total of 647 patients diagnosed with National Comprehensive Cancer Network (NCCN) very low/low risk (VL/LR) or favorable-intermediate risk (F-IR) prostate cancer (PCa) were recognized from a multi-institutional PCa biopsy database in order to verify Decipher to prognosticate adverse pathology at radical prostatectomy in men with NCCN F-IR PCa, and to better pick F-IR candidates for active surveillance (AS). Of 220 patients with NCCN F-IR disease, 53% were classified as low-risk by Cancer of the Prostate Risk Assessment (CAPRA 0−2) and 47% as intermediate-risk (CAPRA 3−5). Decipher categorized 79%, 13% and 8% of men as low-, intermediate- and high-risk along with 13%, 10%, and 41% rate of AP, respectively. Decipher was an independent predictor of AP and continued to be important when adjusting by CAPRA. Notably, F-IR with Decipher low or intermediate score did not relate to significantly greater odds of AP in comparison with VL/LR. In conclusion, NCCN risk groups, including F-IR, were greatly heterogeneous and should be replaced with multivariable risk-stratification. Especially, in this patient population, including Decipher may be beneficial for safely expanding the use of AS.