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Prolaris vs Decipher

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Prostate Cancer
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Posted 2/15/2017 3:45 AM (GMT 0)
What's the diff, is one better than the other?

My DR is trying to get Medicare approval for Decipher. He's also running PreciseMD a less extensive genomic test that tests for 4 mutations. It's proprietary. He says Decipher is better, but if Medicare won't pay for it I shouldn't do it, not worth it. PreciseMD costs $150

Now I'm hearing Prolaris has a guarantee that no matter what insurance does, you don't pay more than $350.

IM G3+4 after surgery negative FINAL margins, but positive intra-operative margin at the apex. No ece. Just lost my "<" at the two year mark, PSA .02, which is what is prompting this.
Posted 2/15/2017 4:34 AM (GMT 0)
Decipher is validated for men after prostatectomies to help decide whether salvage radiation is called for. Prolaris and Oncotype Dx are validated for post-biopsy to determine whether active surveillance is a good idea. Decipher ihas also started including a PORTOS score which has yet to be validated, but is potentially interesting.

None of these are appropriate for you. Decipher is for men with borderline PSA and/or adverse pathology to help decide on adjuvant/salvage RT. I know you are prone to worrying, but there is no one who believes that a PSA of 0.02 is anything to worry about.
Posted 2/15/2017 2:34 PM (GMT 0)
Thanks Allen, good information.

I'm thinking it wouldn't be bad to have the information. If I start trending up, and hit .05 or .07, something like that, having the info would help me make a decision. I don't want radiation that has a low chance of cure.

Also, I'm not sure about my margins any more. I had negative FINAL margins, but positive intra operative. I'm wondering, if I had positive intra operative, I would think that means the surgeon cut thru the cancer, which makes it very possible that cells were released into my system.

As an aside: true, serious, yet unbelievable statement: I'm really not worrying. Somewhat concerned I would say, but not worrying, and certainly not obsessing. It is what it is. I'm probably just immune after the last few years of sh!t happening. If I recur, I recur. I'll deal with it. But till then, I'm just wanting to be prepared just in case.

PS . I know Medicare now covers Decipher for men with adverse technology. So it will be interesting to see how they consider my margins. I expect a call from the Decipher guy today or tomorrow.
Posted 2/15/2017 7:10 PM (GMT 0)
You have nothing to lose and a lot to gain by waiting until you see if there's anything worth worrying about. As you probably know, I don't like unnecessary testing - tests that have no immediate decision implications. They needlessly increase anxiety rather than decrease it. Even if your insurance does cover it, it raises healthcare costs. Let's say it tells you your risk is high - what would you do about it? Have prophylactic radiation? Let's say it tells you your risk is low, but then your PSA creeps up - what would you do? Ignore the PSA? It would only be of value after you have established a uPSA pattern and the decision is otherwise equivocal.

I hope you'll forgive me for a personal observation, but I go by what people do rather than what they say. You are pursuing a genetic test when there is no indication for it, and you say, "I'm just wanting to be prepared just in case." These are hallmarks of anxiety. A moment's thought will convince you that there is no "being prepared" - it is what it is when it is. You have enough to deal with in the present moment without creating unnecessary drama in your life.
Posted 2/15/2017 8:26 PM (GMT 0)
Prato - It's tough spot to be in, trust me I know - Take a look at my PSA numbers.

I looked at my uPSA rise like TA described. "it is what it is when it is"

Regardless of what testing I could have done prior to SRT it would not have mattered. SRT is the last shot at a "cure". If I were to turn it down I would be headed down the hormone path never knowing if I had done the SRT would it have "cured" me? I couldn't live with myself if I hadn't tried "everything" available.

BTW others that have done it often said no big deal, kind of a non event. Well I'm 1/2 way through as of today with both the Lupron and SRT. Fun NO, but so far it really has not been that big of a deal.

Fingers crossed for you - Jon
Posted 2/15/2017 8:26 PM (GMT 0)
Thanks for the input, and personal observations are never a problem for me. I'm not saying i'm not at all anxious, its on my mind but I'm not obsessing. The Decipher was something that Tewari wanted to do, wasnt my idea. Honestly, i would like to know how aggressive my tumor was aside from the gleason. So we'll see.
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