Nomogram and Decipher question

I have continued to read obsessively and look everywhere for all the information I can find to help us navigate the PC road - thankfully, this board is here to seek additional answers when I read myself into a million additional questions. Here are the questions of the day. I ran my husband’s info through the MSKCC post-RALP nomogram. Needless to say, it paints a pretty depressing picture. I am assuming that the predictions provided are based on RALP only and no additional treatment - is that correct? If so, it clearly indicates that my husband will need additional treatment no matter what his PSA looks like at 3 months. This leads to the second question. The surgeon sent my husband’s tissue sample out for a Decipher study - we are still waiting on results. Is this test necessary given his already high risk level? I understand the point of the exam to be useful in determining further treatment based on genomic analysis and prediction of likelihood of future Mets/mortality risk and as a way to not expose guys to the side effects of treatment if not warranted. It seems like a redundancy in his case. Am I off base in not seeing the value here? I just cannot see him not needing follow up therapy if we want the best results. Would love to think cure could still be a slight possibility, and at minimum beat the beast back with everything we have.

Sorry - I’ll repost. Not sure what happened to my signature!

I agree that with that pathology, which includes a positive lymph node, it seems very unlikely that you would not need follow-up radiation and ADT, although that's a very good early PSA score. I think the question as I recall your earlier post is if you go adjunct chemo or not.

Regarding the signature, when you start a new post you typically have to click the "add signature" box.

Decipher will help, at least as much as those nomograms. Good data to have. Request results directly from them and ask for their GRID report.

It looks like RT and some ADT is in his future, but take it one step at a time. Good luck!

The faster you have the Decipher test results and GRID report in your hands, the faster you can start absorbing the details and be better prepared for your physician meeting.

Their excellent customer support number is 888-792-1601. Note they are on the west coast.

Thanks again all. I will have my husband give the customer service number a call and he can request his report. Thanks halbert for the advice re reading too much. Those of us in the medical field tend to do that and to always go to the dark side quickly - will do my best to stop looking things up. It's especially easy for me since I work at a university and have every data base at my fingertips.

^^^^^ ?????

halbert said...
additional treatment may not be needed.

what am I missing? who has positive nodes yet leaves ammo in the gun? Are you saying there's no chance for cure here? (there appears to be to me). Are you saying that he can go on some kind of "AS" with a positive node? I don't remember ever seeing or hearing of this.

Someone correct me if they have. I'm not saying anyone's wrong....including this doctor. What I am saying is this is the first time I've ever heard of anything like this.

Post Edited (island time) : 10/7/2018 12:55:44 PM (GMT-6)

Michael_T said...
IT...could be that since some lymph nodes were removed, the ones that are cancerous were all removed. But to your point, it sure seems like you'd want to zap the remaining lymph nodes as assurance.

Could be. But its known there was a decent amount of pretty serious cancer in the prostate. And you know it has metastasized to at least one node. And its known there's a chance of cancer at the bladder neck. I guess anything's possible. Maybe it was all gotten. Can't nobody say it wasn't I guess. (I don't know if stranger things have happened or not).

I don't mean to be argumentative. Just the opposite. It's just the first time I've ever heard of that chance being taken...that's all. Have you ever heard of this chance being taken or advised by a doctor before?

The reason I ask is that I believe with the amount of experience that is on the forum...an idea can be given as to how common or uncommon the advice and opinions that’s being given to the OP is ... based only on our experiences. No further tx with this path...while doable....may not be commonly done. I don’t believe it is.

Post Edited (island time) : 10/7/2018 2:14:09 PM (GMT-6)

IT, let me be careful here: I was commenting based on the very low PSA at 5 weeks--and considering what the 3 month PSA might be heading towards. If he winds up very low or non-detect at 3 months, there is a possibility that the docs might adopt a watch and wait for an upward trend before doing additional treatment.

Regardless, they can't start adjunct therapy for a while--the surgical injury needs to heal.