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Posted 12/30/2019 6:58 PM (GMT 0)
Can someone in layman's terms explain how to know where you fit in the Decipher test. Or do you have to have this test done just for you.
Posted 12/30/2019 7:05 PM (GMT 0)
Hi Steve. I'm out and about on a tablet. When I get home I'll edit this with links to sample Decipher Biopsy results and some comments. Your report shows you where your Decipher score (on a scale of 0.0 to 1.0) is on a bar graph showing the three categories of risk, low, intermediate, and high. You'll be given your % risk for mets within 5 years and risk for PCa-related death within 10 years. You can see my results in my signature.

This genomic test is based entirely on your cancer's RNA and is independent of G score, PSA history, lesion size or number, etc.

Of course if RT zapped all your PCa and none got established as a micromet prior to, or just after, treatment, the risk drops to near zero.

Your institute should have biopsied tissue blocks or slides in storage, if you opt for the test. Your doc can have your tissue sent for testing. The company, GenomeDx, sends you and your doc the results about 2 weeks after they get your tissue.

Note that Decipher Biopsy results agree with the results on RP tissue (which you obviously don't have) 70% of the time. This depends on the accuracy if one's biopsy to hit the worst category lesion. In the majority of cases it seems that ALL one's mets derive from a SINGLE lesion!

Djin
Posted 12/30/2019 7:40 PM (GMT 0)

DjinTonic said...
Hi Steve. I'm out and about on a tablet. When I get home I'll edit this with links to sample Decipher Biopsy results and some comments. Your report shows you where your Decipher score (on a scale of 0.0 to 1.0) is on a bar graph showing the three categories of risk, low, intermediate, and high. You'll be given your % risk for mets within 5 years and risk for PCa-related death within 10 years. You can see my results in my signature.

This genomic test is based entirely on your cancer's RNA and is independent of G score, PSA history, lesion size or number, etc.

Of course if RT zapped all your PCa and none got established as a micromet prior to, or just after, treatment, the risk drops to near zero.

Your institute should have biopsied tissue blocks or slides in storage, if you opt for the test. Your doc can have your tissue sent for testing. The company, GenomeDx, sends you and your doc the results about 2 weeks after they get your tissue.

Note that Decipher Biopsy results agree with the results on RP tissue (which you obviously don't have) 70% of the time. This depends on the accuracy if one's biopsy to hit the worst category lesion. In the majority of cases it seems that ALL one's mets derive from a SINGLE lesion!

Djin


This is all I can see in my VA records:
DIAGNOSIS:
A. Prostate, right, needle biopsy: Adenocarcinoma, Gleason score 6
(3+3), involving 1 of 5 cores and occupying approximately 3% of the
biopsy; perineural invasion is identified.

B. Prostate, left, needle biopsy: Adenocarcinoma, Gleason score 7
(4+3), involving 5 of 6 cores and occupying approximately 35% of the
biopsy; perineural invasion is identified.

WAS REFERRED TO UROLOGY IN SALISBURY,BUT THEN HE WENT TO SEE A DR. VIC (OUTSIDE
UROLOGIST) WHO HAD REMOVED THE WHOLE PROSTATE W/DAVINCI MACHNE
CT ON 2/28/2014
NO EVIDENCE OF INTRAABDOMINAL METASTATIC DISEASE
LESION ON THE R HIP LYTIC (OLD )
TUMOR SIZE 3.1CM
Posted 12/30/2019 8:03 PM (GMT 0)
Sorry, Steve, I misread your signature in the cafe -- you should have tissue in storage at whatever hospital did the robotic RP, but you can call them or the office of the surgeon who did your RP to check that they do.

You can download sample test results for the Decipher RP test here:
https://decipherbio.com/about-us/resource-publications/#test-reports

The download should have a sample report for a low, intermediate, and a high Decipher score.

If you read through the single-page report, I think you will understand it. Post any further questions you have.

Djin
Posted 12/30/2019 8:03 PM (GMT 0)
steve0 - Decipher is a RNA genomic test on a cancer tissue sample from your surgery. As Djin noted, it is completely independent of all other factors like PSA, Gleason, etc. and is another piece of risk data that one can use when weighing treatment options. A link to the current Decipher site is below:

https://decipherbio.com/prostate/decipher-prostate-rp/

You would have to contact the people who have your prostate tissue from 2014 and have them send a tumor sample to the Decipher people to get it done now which might be a bit difficult.

In your case from your signature, it appears you had RP surgery in 2014 followed by SRT/IMRT in 2017 so there are really no more decisions to be made that a Decipher test would help with in my opinion. Your recent PSA appears to be climbing which means you should probably be seeing a Prostate Oncologist and looking into getting a high powered PET scan done when your PSA is high enough to see if the source of the PSA can be identified and then what treatment options make sense.

There may be some sense in having DNA genetic testing done to see if you have any of the genetic markers that seem to influence cancer susceptibility in people. If you have any of them, it could point to certain treatment options.
Posted 12/30/2019 8:08 PM (GMT 0)
If you insurance will pay for the Decipher test, then, like chicken soup, it won't hurt, but more valuable may be a 68Ga-PSMA-PET scan to locate the source of your PSA, as Mumbo said. The newest-generation scans, like this Gallium-based one, are very good for decision making after BCR. For example there is no point in irradiating the pelvis if you have only a met in a bone.

Djin

Post Edited (DjinTonic) : 12/30/2019 1:43:36 PM (GMT-7)

Posted 12/30/2019 8:08 PM (GMT 0)
Thanks to all... I should be getting a Pet Scan in a couple of weeks and then meeting with my Oncologist to decide on next step.....
Posted 12/30/2019 8:08 PM (GMT 0)
Our posts crossed - steve0, did you have IMRT on your prostate in 2017 or was that related to the hip lesion you noted? Just want to make sure I am not assuming something wrong from your signature.
Posted 12/30/2019 8:13 PM (GMT 0)
One last word about the GRID report that can be requested to accompany your Decipher report. It has theoretical scores for how you cancer may respond to RT, ADT, one chemo drug (doxetaxel), and one immuno drug (dasatinib). The GRID report is technicaly "for research purposes only," and hasn't been validated for clinical decision-making, but it could nonetheless tip the scale if you and your docs are one the border about the best treatment(s).

Djin

Post Edited (DjinTonic) : 12/31/2019 10:21:19 AM (GMT-7)

Posted 12/30/2019 9:48 PM (GMT 0)

Mumbo said...
Our posts crossed - steve0, did you have IMRT on your prostate in 2017 or was that related to the hip lesion you noted? Just want to make sure I am not assuming something wrong from your signature.

Sorry it was for PC....
Posted 12/31/2019 1:07 AM (GMT 0)
It's been quite a while since posting on Healingwell. But it's great to see this site still helping people after all these years. I'm posting because I have some good inside on molecular biomarkers for prostate cancer. The American Society of Clinical Oncology (ASCO) released earlier this month a paper on the use of molecular (genetic) biomarkers for prostate cancer. I served on this panel with these docs for almost two years as we went through hundreds of relevant papers on the use of them. This was published on the 10th and it describes well the use of these assays and the reason for their use. The primary reason - when it may influence a decision.

https://ascopubs.org/doi/full/10.1200/jco.19.02768

Tony
Posted 12/31/2019 1:23 AM (GMT 0)
Tony I guess you haven't posted in awhile. Your post deserves it's own heading. Why don't you create a new post with the info? You posted as a 9th comment here.
Posted 12/31/2019 1:23 AM (GMT 0)
Thanks, Tony. I think the Bottom Line summary there is in line with what uros have been doing, from what I gather. Testing with validated tests can be helpful for (1) making AS vs. treatment decisions in borderline cases and (2) decision-making regarding adjuvant and salvage treatment.

Djin
Posted 12/31/2019 4:49 PM (GMT 0)
Djin - I would think that genomic test results may also influence the addition of ADT to treatments. Trying to know when to throw the kitchen sink at a situation requires evaluation of any and all data in many cases IMO.
Posted 12/31/2019 5:20 PM (GMT 0)

Mumbo said...
Djin - I would think that genomic test results may also influence the addition of ADT to treatments. Trying to know when to throw the kitchen sink at a situation requires evaluation of any and all data in many cases IMO.

Yes, indeed -- I will edit my post above about the Decipher test's companion GRID report -- it does have an ADT-response score. Mine was a dismal 1 out of 100! The score isn't really how well your PCa responds (it's usually all or nothing), but rather an estimate of how long you will remain castration-resistant.

While on this topic, when I pointed out my poor ADT score on my GRID when my uro and I first got it. However we mistakenly thought it had to do with the type of response rather than the duration. My uro said that while he had always seen the figure of 10% for the percentage of men that won't respond at all to ADT, he said in all his years of practice, he's never had a patient that did not response initially, even it was only for a short time.

Thanks for catching that, Mumbo!

Djin

Post Edited (DjinTonic) : 12/31/2019 11:20:31 AM (GMT-7)

Posted 1/1/2020 2:43 PM (GMT 0)
I was also thinking about when one is sitting on the fence (like me considering ADT with ART). My RO said there was no benefit to adding ADT with non-detectable PSA and ART based on most recent studies. He said if I insisted, he could add it but did not recommend ADT for my situation. I looked at all info available to me including my low average risk Decipher and agreed with him. I think the same might hold true for various radiation treatments where risk levels are lower including a low Decipher score. Just my random morning thoughts on the matter.
Posted 1/1/2020 3:06 PM (GMT 0)
Yes. That is the valuable help that the Decipher score itself provides: the risk that your particular PCa will metastasize. I agree that it appears to be especially useful for deciding on ART vs. ART+ADT and SRT vs. SRT+ADT. Note that the Decipher cutoff values for the low/intermediate and intermediate/high labels are somewhat arbitrary, and your score is just above low risk.

I might be more cautious about skipping RT for salvage treatment after RP, though. IMO RT seems to usually be in the cards for BCR. I see great value in the new generation PSMA-PET scans to identify the location(s) of PSA sources and see where to irradiate (where possible). The problem here is that these scans are less accurate at the very low PSA levels we often have when adjuvant and very early SRT are now being considered.

Dr. A. D'Amico recently stated that G9-10 men choosing RP should be told that if they have at least one major adverse finding at surgery, EPE+, SVI+ or SM+ (or LNI+ of course), they should think of adjuvant therapy as an integral part of their primary treatment!

The new ASCO guidelines on genomic testing (See Tony C.'s post above) emphasize its value for decisions about adjuvant and salvage therapies.

Djin
Posted 1/1/2020 5:01 PM (GMT 0)

DjinTonic said...

Dr. A. D'Amico recently stated that G9-10 men choosing RP should be told that if they have at least one major adverse finding at surgery, EPE+, SVI+ or SM+ (or LNI+ of course), they should think of adjuvant therapy as an integral part of their primary treatment!

Just keep in mind that while a very accomplished one, Dr. A. D'Amico is still a radiation oncologist.
Posted 1/1/2020 5:04 PM (GMT 0)
True, however this is for post-RP men, and, if I remember correctly, the statement was for some form of adjuvant, which in some cases could be just ADT.

Djin
Posted 1/1/2020 5:37 PM (GMT 0)

DjinTonic said...
True, however this is for post-RP men, and, if I remember correctly, the statement was for some form of adjuvant, which in some cases could be just ADT.

Djin

That is correct, and D'Amico has a history of being aggressive when prescribing ADT. He wanted me on three different ones, simultaneously. Classic triple header.

What are you doing here ;-)))
Posted 1/1/2020 6:31 PM (GMT 0)
Djin - My URO and RO were both were suggesting ART but just as quickly backed off if I wanted to wait. They both were concerned about regaining full continence and ED first then proceeding with RT which kicked the ball back in my court for the final decision. Since I did not have a continence issue, I decided to proceed ahead and leave ED for another day. The balancing of possible side effects against a potential "cure" of a problem you may or may not have is a tough mental decision.
Posted 1/1/2020 7:18 PM (GMT 0)
Mumbo, I fully understand the dilemma and can't fault your decision! If I had been faced with SM+ and EPE+, I would have wanted the big guns soon with my G9, too.

With respect to the timing of the start of RT, it's not at all clear to me the time frame that qualifies it as ART vs SRT. Some have defined ART as up to a year following RP. Most want patients to have some healing time in any case.

Djin

Post Edited (DjinTonic) : 1/1/2020 12:23:04 PM (GMT-7)

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