Decipher Test

Now that I've had the test, I did what I typically do, surfed the internet looking for data on the validity and utility of this fairly new genomic test.

What it's done for me, having come back with a low risk score, if 37, is made me a bit less anxious about a VERY small rise in PSA. And also I think I might be less ggressive about looking at SRT at say .05, if I ever get there, vs the traditional, or as my Uro referred to it, "gold standard" for SRT, of .1.

It seems also that this is a terrific tool for determining whether AS is a good idea after a biopsy that indicates low or intermediate risk cancer.

Here's an article that I think is worth reading, for anyone struggling with a related issue. it's a discussion of a compendium of studies on the value of the test.

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4859922/

Decipher is pretty good at predicting if you won't have metastases in the next 5 years (they are predicting 10 years now). So, if your Decipher score was under 0.4, you can be reasonably certain (98.5% odds that it predicts rightly) that mets won't show up for at least 5 years. But it isn't so good a predicting those who will - a score over 0.4 incorrectly predicted metastases in 5 years about a third of the time.

The problem with reliance on it is that the median time to go from biochemical recurrence (0.2 ng/ml) to detection of first mets is 8 years. So it can easily be longer than 10 years from the time a uPSA becomes measureable. And the cancer is undoubtedly micrometastatic and systemic in at least some of the interim. Remember that the genomic classification is a portrait of the tumor as it existed at one point in time. As cancer progresses, it gets increasingly genomically unstable.

Genome Dx (the company that makes Decipher) is experimenting with a new indicator called PORTOS, which they hope will be able to sort those that will benefit from salvage radiation from those who won't. It's too early to rely on it.

/pcnrv.blogspot.com/2016/11/portos-gene-signature-that-predicts.html

PORTOS is new - they just started reporting it. .37 is just under their dividing line.

Here's some additional info about Decipher that I wrote up a couple of years ago. Note the discussion with Genome Dx on the bottom:

Genomic classifier can help identify patients who may not need adjuvant radiation