Decipher test canceled due to high Gleason 8

[Dachshundlove]

Has anybody ever been told that genetic testing on their biopsy was canceled due to high Gleason?

We got this call today and I can’t figure out what it means?

The tumor was going to be sequenced by Decipher.

Thoughts appreciated!

[pjoshea13]

Decipher is useful to identify aggressive disease (i.e. it can be used to predict metastasis & mortality.) Gleason 8-10 is, by definition, aggressive cancer.

Decipher would be more useful in the more common Gleason <8 cases, where it isn't obvious which cases require aggressive treatment.

-Patrick

[Dachshundlove in reply to pjoshea13]

Thank you for the info. Now it makes more sense why it was canceled. His is a Gleason 8 and appears to be in lymph nodes so we are already treating.

~to time well spent.

[Garbonzeaux in reply to pjoshea13]

"Gleason 8-10 is, by definition, aggressive cancer."

I've never quite understood this statement. how do we know that a high Gleason score, which is based on the appearance of the prostate tissue, is indicative of a rapidly advancing disease rather than one which has been slow growing for 20 or 30 years?

[pjoshea13 in reply to Garbonzeaux]

When I was diagnosed, I assumed that PCa progressed, slowly or quickly, through the Gleason scores - for all men. The statement that most will die with, but not of the disease is true because it is a minority that progress to GS 8-10. For those men, the statement is false.

"the majority of metastatic prostate cancer (mPCa) will arise from tumors with Gleason scores (GS) of 8 to 10" [1]

"high-risk prostate cancer classified as PSA ≥20 ng/mL, Gleason score 8-10, or ≥T3 disease." [2]

"Aggressive cancers (eg PSA >20, ISUP grade group 4 or 5 [Gleason score 8-10], or stage T3-4) usually warrant imaging scans to determine the presence of metastatic disease." [3]

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/246...

[2] ncbi.nlm.nih.gov/pmc/articl...

[Dachshundlove in reply to Garbonzeaux]

It’s a interesting point.

It feels like the professionals make many assumptions/ guesses and sometimes they wind up being right (great when they do) and other times they are totally wrong.

[Tall_Allen]

Decipher on biopsy is only used by patients who are sitting on the fence about active surveillance. You are not a candidate for active surveillance - you need treatment. Decipher would play no role in your decision.

[Dachshundlove in reply to Tall_Allen]

As always-/ thank you for the time and wisdom.