DECIPHER GRID revisited

[Jmr11820]

What is the current thinking on DECIPHER GRID? I posed this question a few months ago and the consensus was to not use it for clinical decision making. In fact they refer to it strictly as a research tool. However, seems I continue to seem more studies validate not only DECIPHER but also the GRID. In my case, DECIPHER is high risk and the GRID shows relatively low response to both radiation and ADT. It shows a high response to docetaxel. Seeing urologist this week for 6 month follow up. Plan was to start RT at 6 months given the high risk DECIPHER, without regard to GRID. I am ready to move forward with a plan but the GRID treatment probabilities give me pause. Welcome any information or experience with DECIPHER GRID.

[Tall_Allen]

It hasn't been prospectively validated. Their first iteration was called PORTOS. I think the same considerations may apply:

pcnrv.blogspot.com/2016/11/...

[Jmr11820 in reply to Tall_Allen]

Pretty compelling. What primarily determines whether ADT is advisable along with RT? Is is the grade of the disease, current PSA, or something else?

[Tall_Allen in reply to Jmr11820]

For SRT, ADT can make a difference if the PSA>0.6. But if you had GS 9-10 or PSA>20 or some rare subtype (particularly those with low PSA), you might want to adjust that downward.

[Jmr11820 in reply to Tall_Allen]

Thank you.

[Jmr11820 in reply to Jmr11820]

Today my urologist let’s do RT given my high Decipher and small PSA rise over last 3 months. I think it’s the right call, except I can’t get my head around high risk DECIPHER and benefit Of adjuvant RT alongside a low radiation response score. Does DECIPHER trump PORTOS (for lack of a better word).

[GARunner1]

Can't comment from a research based view, but only from my personal experience. I was diagnosed in June 2014 after a diagnosis of Gleason 7 (4+3). After the surgery the Decipher analysis (an earlier version of the one in use today) showed average risk and very low chance of reoccurence within five years. My PSA post surgery was undetectable. In March 2016 my PSA began to slowly rise reaching 0.3 in September 2016. The GRID was just coming out and a very early version suggested radiation without the need for ADT. For various reasons I started on monthly Lupron shots in October prior to radiation. My PSA went to 0.1 in December 2019 and went to undetectable in January 2017 before the 39 sessions of IMRT which started in January and ended in March 2017. I have been undetectable since then.

You might say the Decipher tools did not work for me, but the current versions may have better predictability. As with most things with PCa, you pay your money and take your chances. Having ADT with a PSA of <0.6 did seem to work for me, at least so far. Wishing you the best of luck.

[Jmr11820 in reply to GARunner1]

Thanks for sharing your tale. MY PSA is . 03, up from .01. Plan is to do RT, no ADT, because of adverse pathology and high DECIPHER. Seemingly no consideration of my poor radiation response probability from DECIPHER. Doc (urologist) says at this early stage if RT is not effective we still have time to do ADT. Conversely if RT is effective we’re ahead of the curve early on without ADT side effects. Kind of a process of elimination. Hadn’t heard that rationale, sounds suspect to me. Meet with RO next week to hear his plan. Congratulations on your success.

[GARunner1 in reply to Jmr11820]

Best of luck. One more thought. When I was discussing what to do, I was told the ADT acted as a catalyst to help the radiation do its job by weakening the PCa cells, thus increasing the chance of the radiation working. Don't know if there is science behind that theory, but you may want to ask about it.