Good Morning! Had my 2 week post RP urology appointment yesterday and because I have some adverse results on my pathology report they have submitted samples for Decipher Genomic testing. There are 22 RNA markers that are good predictors of reoccurrence. These genomic markers or combination will determine that likelihood. If they come back positive then I will have some subsequent treatment, likely radiation. This is also contingent on my 90 day post op PSA test. This reduces the over treatment of the cancer because the pathology does not always mean reoccurance (which in my case would be 50% based on pathology alone). People are often given unnecessary treatments as a result. PC is one area where there has been so much over treatment that it has resulted in a large number of people being under treated (like me). So basicly good news despite what appeared to be bad news The Doc said I’ve over analyzed this and to just chill. I told him I was adrift in a sea of acronyms and been up too late trying to read Chinese medical journals.
Look at the post op video That explains this test
What were the adverse results?
Tall, Here is my Pathology summary
TUMOR Acinar adenocarcinoma
% of Pattern 4 70%
% of Pattern 5 5%
Primary Gleason Pattern Pattern 4
Secondary Gleason Pattern Pattern 4
Tertiary Gleason Pattern Pattern 5
Total Gleason score 8
Intraductal Carcinoma (IDC) Present
Extraprostatic Extension (EPE) Present, nonfocal
Seminal Vesicle Invasion(SVI) Present, right
Perineural Invasion Present
Margins Uninvolved by invasive carcinoma
Lymph nodes Uninvolved by invasive carcinoma
Pathologic stage classification
Primary tumor pT3B
Regional lymph Nodes pN0
Addl Pathological Findings High-grade prostatic intraepithelial neoplasia (PIN)
So, on the upside, there are no positive margins and the lymph nodes they sampled were clear. On the downside, there's IDC-P, tertiary 5, SVI, & EPE - you don't need Decipher to tell you it's aggressive. You might want to move up your ultrasensitive PSA to 6 weeks post-prostatectomy.
Allen, I do understand the implications of my negative pathology results. I only hope that the Decipher test will help determine the next course of treatment. I don’t feel very optimistic at this point and am expecting a negative prognosis.
I wish you well, kpminn!
The Decipher score will not determine the next course of treatment in your case, but the uPSA will.
I understand that the Decipher test will risk of metastases within 5 years and that for death due to PCa within 10 years. Won't this and post op PSA determine course of treatment?
As I said, you already know it's aggressive. There's no such thing as a diagnosis of IDC-P, tertiary 5, SVI, & EPE that's not aggressive. So Decipher really only confirms what you already know. If you don't get confirmation, I would question the test. Either way, uPSA alone will determine if and when salvage radiation is needed.
So then are you saying that the uPSA is the only way to determine if and when RT is needed?
In your case, yes, because of your aggressive pathology - any uPSA over 0.03 at 3 months or (over 0.04 at 2 months) warrants a discussion with a radiation oncologist.
You're a very luck man you've got TallunderscoreAllen on your side.
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 01/05/2019 5:17 PM EST