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Decipher Genomic Test Result: Advice Needed

Restored1
Posts: 17
Joined: May 2019

Please I need your opinion on my genomic test result (result attached). I am tempted to continue with active surveillance but 2 different uro-surgeons adviced me to do robotic surgery. I am 56. The result of the genomic test is 0.44 on a scale of 0-1.0. Genomic risk is low and it shows the risk at the tip of the high point of LOW and just before the Intermidiate level. Risk of High Grade Disease at Radical Prostatectomy is 21.7%, risk of mastasis within 5 years is 3.7% and risk of prostate cancer death within 10 years is 4.4% Advice please.

hopeful and opt...
Posts: 2265
Joined: Apr 2009

First there are various active treatments for prostate cancer, some better surgery. Surgeons most often recommend surgery, and radiation oncologists most often recommend radiation. When active treatment is indicated the guidelines call for the doctor to present all treatment options to the patient. One would think that this should be without bias.

Please provide all pertinent information about your situation, to include PSA history, biopsy pathology to include number of cores taken and amount of cancer in each core that was positive. Any other pertinent findings in the pathology. MRI taken? Any other diagnostic tests, FREE psa, etc etc Size of Prostate 

AS Advocate and myself are enrolled in active surveillance protocols for many years and can provide input based on our experience and extensive research . Others here also add valuable comments 

Restored1
Posts: 17
Joined: May 2019

Thanks for your response, it is very much appreciated. My PSA scores are 6.7 on 11/14/17, 3.7 on 3/23/18, 4.5 on 10/25/18, 3.9 on 7/1/19, 4.4 on 9/7/19, 5.8 on 2/2/20 and 4.1 on 6/6/20

I have had 3 different biopsies between 2017 and 2019. 12 samples taken and between 4 and 5 cores came back with Gleason 3+3. Lowest percentage of cancer invlolvent is 3% and highest involment in one of the samples was 21% involvement. I hope this helps a bit? Thanks

VascodaGama's picture
VascodaGama
Posts: 3234
Joined: Nov 2010

Restored,

The result is good. I wonder why you compare your low case with the intermediate (0.45–0.59). The results signifies that you got low probabilities in having identified metastases (extraprostatic extensions) on the report provided by the pathologist that will analyze the gland specimen. Low risk gives you the opportunity of continuing your commitment to AS. You need to check again this genomic risk at your next biopsy.

Please read this;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674810/

Best,

VG   

Restored1
Posts: 17
Joined: May 2019

Thanks VG for your insight and advice. You are appreciated.

PayneOrtho61
Posts: 7
Joined: Jul 2020

I am 59 and was just diagnosed with PCa with a Gleason of 3+4 and I had the Decipher Genomic test on my biopsy.  My Decipher score came in at .67 which is in the high risk region of the test.  My score is pretty clear cut as to what I need to do, either radical prostectomy or external radiation.  My cancer is still contained in the prostate with no involvement of other structures so it is considered intermediate, but I must treat the cancer difinitively in the next 6 months. I am in the research stage trying to figure out what the best approach is for me.  What was your PSA and Gleason score and percentages of cancer tissue involvement on the biopsy cores?  It sound like you might be ok to do active surveilence, what did your urologist reccommend?  Please stay in touch as we are on similar paths, although I am probably little ahead of you and will let you know how things progress.  Stay strong!

Restored1
Posts: 17
Joined: May 2019

Hi, my Gleason score was 6 (3+3) and my urologist is recommending RP due to number of cores involved. (5 out of 12). I am kind of confused because I don't wanna deal with the possible side effects of RP. I wish you the best on your journey. many thanks for your input.

hopeful and opt...
Posts: 2265
Joined: Apr 2009

Gleason 6 does not leave the prostate, however when there is a lot of Gleason 6 there can be higher grade cancers in the prostate that can leave the prostate. In your case, there is a good amount of Gleason 6 and it is very possible that there is can be higher grade cancer, and you are not a candidate for active surveillance. Please be aware that men with a small amount of Gleason 4 qualify as candidates.
There is a difference of skill among pathologists, the doctors who examine the pathology found in the prostate.....as a general rule it is appropriate to have a second opinion from a world class pathologist who can look at your slides and confirm the results of your pathology. Jonathan Epstein of Johns Hopkins is considered a leader of this medical specialty. Contact your doctors office so these slides can be sent.....depending on your insurance there may be a $250 charge. Your treatment decisions will be based on this information.
Apparently you had a random biopsy, and did not have a targeted biopsy based on a T3 MRI that would provide better information about where you stand; that is, more aggressive cancer is found with this targeted procedure and is more effective in finding cancers in the prostate.
Additionally a T3 MRi can show extracapsular extension, that is if there might be detectable cancers outside the prostate, can also show suspicious lesions within the  prostate, one lope or two, etc. This is critical to a treatment decision.
The results of the Decipher test that you had was on the border of low and intermediate. The scale of this test is continuous, and your number are on the border of low and intermediate
You mentioned your PSA's however you did not mention the prostate size...a piece of the puzzle to help decide on whether or not to enter an Active surveillance programor is a psa/prostate density. The number needs to be less than 0.15...basically large prostates press on the uretha and secrete more psa's

You are only 56 and have need to be a little more rigid in entering an 
AS program than an older man.
If I was in your shoes I would speak with an expert in Active Surveillance, at a teaching hospital, a center of excellence,  to review your information, and give a professional medical opinion in order to continue with AS. At this point for me, a layperson, with the limited information that you provided I cannot recommend AS, however AS may be possible, but this decision is above my pay grade.
You mentioned that the surgeons that you saw recommended surgery. Generally surgeons recommend surgery just as radiation oncologists recommend radiation.
In my opinion that are less invasive active treatments than surgery that will be just as effective as surgery with less side effects. I am attaching another thread that gives an introduction to treatment decisions, etc.
 
 
Please keep on posting with your questions
 
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