DECIPHER news

[Jmr11820]

I read yesterday that a new phase RTOG 9601 validates DECIPHER as a predictor of OS, and also showed ADT to be beneficial in DECIPHER high risk men receiving ART, especially those with low PSA. This seems counter to a previous trial that showed men with very low PSA had no ADT benefit with RT, and in fact it may be detrimental. As a high risk DECIPHER patient who relied in part on the past data, I’m wondering which guidelines apply. Any thoughts? Am I missing something here?

[Blackpatch]

Hi Jmr

My Decipher is 0.91; Decipher isn't really used in Australia but the reaction of the people I consulted was to include 18 months ADT even though my PSA at eSRT was only 0.12.

The PORTOS blue dot at a very high 87 was the only good news on my GRID and I grabbed it with both hands. At the time, I consulted one of the authors of the study you're referring to and his view was eSRT + 12 months of ADT would be enough given the low PSA and zero burden on PSMA PET. I also took (and am continuing with) the Care Oncology re-purposed suite of drugs - that 0.91 really freaked me out with its 47% 5 yr metastasis and 23% 10yr PCSM.

Almost two years post-eSRT, my testosterone has recovered and so far my PSA is still <0.01, but I have another three monthly check coming up and it is still making me nervous.

Stuart

[Blackpatch in reply to Blackpatch]

Sorry - premature cutoff there (sadly, I have nothing else to be premature with these days!)

I haven't been able to access the JAMA paper but this extract seems to say it all...

"Although the original planned analysis was not powered to detect a treatment effect interaction by GC score, the estimated absolute effect of bicalutamide on 12-year OS was less when comparing patients with lower vs higher GC scores (2.4% vs 8.9%), which was further demonstrated in men receiving early sRT at a prostate-specific antigen level lower than 0.7 ng/mL (−7.8% vs 4.6%)."

So high Decipher men saw an 8.9% 12 yr OS imrpovement with +ADT cf. only 2.4% for low Decipher; Men with low PSA (<0.7) saw a 7.8% drop in 12 yr OS with +ADT whereras those with a higher PSA saw a 4.6% survival imporovement.

The way I interpreted this in the absence of the full text is that high-Decipher men gained twice as much survival benefit as high-PSA men when both groups were +ADT.

Stuart

[MateoBeach in reply to Blackpatch]

Congratulations on your great results after eSRT. May that it persist off ADT.

[Blackpatch in reply to MateoBeach]

Thanks - I hope so too. But the RO who did the job very kindly spotted that my lungs looked crap on the CT scans done for the PSMA scans. The net result is I have been diagnosed with IPF, which means my lungs are fibrosing.... sort of like aging ultra-fast.

So now I get to stress about the regular lung function testing that is mapping the decline. The drug i’m on for life can halve the decline rate but it’s also a lung cancer chemo drug and makes me throw up randomly!! Still, better than the alternative - untreated, survival is 2 - 5 years...

It feels like a fire and frying pan moment.... people talk about surviving PCa long enough to die of something else, but I kind of thought that implied 15+ years, not 5!! Just gotta keep rolling with the punches, I guess.

[Jmr11820 in reply to Blackpatch]

IPF... is that associated your treatment?

[Blackpatch in reply to Jmr11820]

Nope... the “I” is for idiopathic, meaning the cause is unknown. Most probably down to swimming in plaster dust when I was renovating a house I had in the UK ten years ago. So much for DIY...

[Jmr11820 in reply to Blackpatch]

One other question... have you done genetic testing? Seems like a logical next step for those of us with high genomic score. I’m planning on asking my urologist about it when I see him next month for the dreaded PSA test.

[Jmr11820 in reply to Blackpatch]

Thanks for your response. I sought opinions from 1 urologist and 2 RO at the time I was starting RT and all suggested no ADT. Also, those opinions were supported by a study by Dan Spratt at the time. But now it seems ADT might have been a good choice for me. That said, I’m a 17 months post surgery and last PSA was .00. Like you, I get uptight before every PSA check, especially because of high risk decipher disease. Best to you, hopefully we’ll both have many good years ahead. Take care.

[Blackpatch in reply to Jmr11820]

I saw the same study and corersponded with Dan because the work they published first only addressed the negative outcome for "all" low PSA men having eSRT and that made no sense, At the time, they hadn't done the work to segment by Decipher (or PORTOS or anything else) - I'd already decided ADT was necessary, and there was no option to wait for them to publish.

There's no doubt that a significant proportion of the ADT benefit comes from its synergy with the SRT - but it's something you could revisit if you ultimnately need to look at, for example, SBRT directed at isolated re-occurences detected with PSMA PET.

[Jmr11820]

I exchanged messages with him today. I was pleasantly surprised when he responded. He said that low PSA (<0.7), high risk DECIPHER guys treated with ADT had roughly a 5% survival benefit over those who had RT only.