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Deciphering Decipher results

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Posted 9/27/2021 5:43 PM (GMT 0)
I just got back my Decipher score, it is 0.54 which puts me in the middle of "Intermediate Risk" with 4.1% and 8% risks of 5 and 10 year metastasis.

I was diagnosed in April w/stage T3a PCa w/ GS 3+4=7 and <5% Gleason 4, but 50% of cores Positive. The staging classifies me as High risk, but my MO chose to treat me relative to my Gleason score as Unfavorable Intermediate, and I am 4 months into a 6 month course of ADT, having completed 5 weeks of PBT to prostate and pelvic lymph nodes.

My question (which I am asking my MO, but thought I would throw out here for your opinions) is whether the genomic score should edge me back toward High risk, with some extension of ADT - maybe not to 3 years, but perhaps 12 months rather than 6?
Posted 9/27/2021 6:01 PM (GMT 0)
Hi Vynbal, Of course we're not doctors, but my guess is that your MO will say no to the risk category, but may go along with you about continuing the ADT if you want to, perhaps along the lines of "I don't think it's necessary, but we can extend it if you want to."

I had a surgery for my G (4+5) with no further treatment (so far) since I was pT2 in the post-op path report. My Decipher score (done on RP tissue), was 0.37, low-risk, up toward the bottom (0.45) of the intermediate-risk range. For comparison, my Decipher 5-year risk met risk is 2.4% and the 10-year risk is 3.3%

I assume your MP based your treatment plan on an assumption that you were intermediate/aberage risk for mets.

You can also request the free, accompanying GRID report. It has not been validated like the Decipher test itself, and, the company says, is not for clinical decision making. But it does have a score (0-100) for your cancer's theoretical responsiveness to RT, along with much other technical info about your cancer based on its RNA. While you shouldn't let it determine your treatment, IMO, it could be a helpful "tiebreaker" if you are really unsure. Keep in mind that if any PCa did establish itself out of the RT field, ADT will only keep it at bay, AFAIK. So HT could always be resumed in the future if necessary -- something to ask your MO about, perhaps.

Let us know what your MO says and what you decide.

Thanks,

Djin
Posted 9/27/2021 7:12 PM (GMT 0)
Not sure what the MO would recommend, but as Djin said above, if you wanted to extend ADT I wouldn't picture a doctor saying no to that. I'd guess that in general, doctors are trying to convince patients to stay on ADT longer, but as I recall from another thread you're handling ADT pretty well.
Posted 9/27/2021 9:30 PM (GMT 0)
ADT before and during radiation treatment for your biopsy diagnosis makes sense to me. The length of the ADT period after treatment has ended is not so clear. If your ADT is for 6 months total, that would seem to be on the low side.

Your biopsy diagnosis is limited in that it only looks at the samples obtained and not the remaining 99% of the prostate. It is possible that you have some G7(4+3) lurking about that was not sampled. This is definitely a good topic to discuss with your MO and share your concerns.

Here is a link that may be of interest: https://www.pcf.org/news/18-month-adt-optimal-for-locally-advanced-prostate-cancer/
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