Decipher Results

[Elbers123]

I now know I’m in the 10% worst category for genomic results. 20% chance of Mets in 10 years 25% chance of death in 15. Not happy. It’s out of my hands. They will ADT me then prostate bed and lymph node radiation. I guess I kinda always knew. I’m assuming someone has determined these steps are required to achieve those stated stats. Meaning if I do nothing my chances are even worse ?

[Tall_Allen]

Those are the stats if you do nothing.

[Elbers123 in reply to Tall_Allen]

Thanks

[SongofFred in reply to Tall_Allen]

Are you sure TA? I, too, am high Decipher and in many places on my Decipher report it says specifically these risk percentages are based on post RT or RP therapy.

To quote: “15-year risk of Prostate Cancer Mortality with RT or RP is 19.5%”.

And again later on: “This patient has a predicted 17.6% 10-year risk of metastasis with radical therapy (eg., radical prostatectomy or radiation therapy)”

And under the Decipher test description it says: “5-year, 10-year risk of clinical metastasis and 15-year risk of prostate specific cancer mortality (PCSM) after curative intent therapy”

I certainly hope you’re right, but I’ve scoured the report and I don’t see anything on the pages suggesting these numbers are based on no treatment. Could you help me understand this?

Thank you.

[maley2711 in reply to SongofFred]

It is what it says.....I'm sure Google and pubmed will confirm what it says!!!!

Anyway, those are stats, and why not assume you will not be in the 75% with better results???

[SongofFred in reply to maley2711]

Well it also says after definitive radiation therapy without hormone therapy I still have a 50% chance of biochemical failure in five years. It would be prudent to assume I have 50% chance of spending my life on ADT or worse and act accordingly. So I got HDBT, full pelvic radiation, and am doing one year Orgovyx/Nubeqa. I’m putting a lot of weight on the Decipher results. I know they have 95% accuracy, but what we don’t know yet is exactly how much hormone therapy will decrease the risks. Decipher is just too new and trials to determine ADT’s effects on reducing the Decipher risk percentages are just in early stages, so we just have to wing it.

Am I over-treating it? Maybe. So it would be great to know if TA has some insight as to the test actually being based on stats of men who did nothing, because that would make the Decipher conclusions far less worrying.

[Elbers123 in reply to SongofFred]

We seem to be on parallel paths. Good luck !!

[Tall_Allen in reply to Elbers123]

No, you are in completely different situations.

[Tall_Allen in reply to SongofFred]

There are two Decipher tests. One is based on biopsy cores and is given to patients considering active surveillance. It gives the genomic risk of 5 and 10-year met-free survival for standard care.

The other Decipher test is based on post-prostatectomy specimens, which is the OP's situation. It is based on prostate tissue provided after a prostatectomy. It gives the risk of 5 , 10, and 15 -year metastases if you do nothing further. It is an aid in helping you decide whether you need salvage radiation. They also provide the 5-year risk of progression for salvage RT for your Decipher risk group if treated at various PSAs. They also give the 5=yr risk of radiation failure.

decipherbio.com/decipher-pr...

[SongofFred in reply to Tall_Allen]

Wow. Thank you for clearing that up! A year of studying and I missed that completely.

So it seems that, if you took two Decipher reports, one post-biopsy, and one post-prostatectomy, and they both showed a 15 year risk of PCSM at 20%, it would actually be a benefit to the prostatectomy patient because they have both radiation and ADT to fight against that 20%, whereas radiation is already baked into the biopsy version of the Decipher report so they only have ADT to add to the fight.

[Tall_Allen in reply to SongofFred]

No. The biopsy report gives the risk of metastases with standard care, not salvage.

[RJAMSG in reply to SongofFred]

My Decipher score is High Risk and says the same thing, I’ve been undetectable after surgery > 4 years ago with no other treatment so far. My philosophy is I’ll die when my Creator calls me home and no sooner/later and live each day to the fullest.

[RMontana]

I have a Decipher score of 0.97; wonder sometimes why they even bothered and just did not make it a solid, whopping 1.0 max score! I am not sure what your score was, but from the MET and CSM percentages you posted its not that bad! You may have a low Decipher score (< 0.40) and if that were the case then less aggressive treatment would have been the right choice. Here is what I have found on Decipher; once your treated its predictions are 'static,' in that once you do treatment the prediction change! Makes sense, does it not. See if the LINK works, if not this is the relevant text;

Perplexity Ai; "The Decipher test does not have its predictive values for metastasis and mortality directly changed by early salvage radiation therapy (SRT); rather, the test provides a risk score that can inform the decision to use early SRT after radical prostatectomy. The test's results can influence clinical decision-making by identifying patients who may benefit from more aggressive treatment, such as early SRT, based on their genomic risk of metastasis.

According to the PRO-IMPACT study, the use of the Decipher test was associated with changes in treatment recommendations. After Decipher testing, a higher percentage of high-risk patients were recommended to receive more intense therapy, such as SRT and androgen deprivation therapy (ADT), compared to when only clinical and pathological characteristics were considered, ref 1

. This suggests that the Decipher test can lead to a change in the treatment plan, potentially including the use of early SRT, for patients with higher genomic risk scores.

Additionally, among men with early biochemical recurrence (eBCR), those with high-risk Decipher scores were more likely to receive salvage treatment compared to those with non-high-risk scores, ref 8

. This indicates that the Decipher test results are being used to guide treatment decisions and may lead to the early initiation of SRT in patients with higher genomic risk.

In summary, while the Decipher test itself provides a static prediction based on the tumor's genomic profile at the time of testing, the introduction of early SRT as a treatment option can be influenced by the Decipher score. The test helps to identify patients who are at higher risk of metastasis and mortality and who may therefore benefit from early SRT, potentially improving their outcomes compared to what might have been expected without such treatment; ref 1, 8.

LINK: perplexity.ai/search/is-the...

For PSA doubling, check out this discussion...it matters. I believe doubling at less than 15 months is the criteria to worry about...

healthunlocked.com/active-s...

I have had a total of 21 months of ADT. If you need it, if you will benefit from it, take it. Do so with your eyes wide open. ADT treatment will end your sexual life and it will be gone for good. Your libido may not recover and there are impacts that you need to know about before you take it. There are also things you can do during treatment to alleviate its impacts! BUT if you need it, TAKE it (I needed it or I would be really bad off right now). Check this out as its the only honest discussion of ADT treatment I have ever found. Go figure, its all woman URO's! My male doctors did not tell me ANYTHING about these impacts, zip, nada, niet!

healthunlocked.com/active-s...

But stay cool (if that is possible). Read up on what your options are. Make an informed decision. Get baseline testing for EVERY THING...then choose a treatment and pull the trigger; dont look back...good luck... Rick

PS if you have not signed up for a Ai (artificial intelligence) search engine yet DO SO immediately...dont waste any more time with Google...Ai is amazing at finding out what you need to know...get one of the many engines that are out there...I use Perplexity and am astonished how good it is...TNX

[LowT]

I believe the percentages were determined from men who had “persistent PSA after prostatectomy”. So if PSA is detected months or years out are those numbers applicable?

[jazj]

I would question the relative importance of this one data point considering it doesn't take into account many other important factors. A Medical Oncologist would use your DECIPHER score as one of several data points to recommend a treatment strategy. I'm no MO but I believe the other things that are typically factored in, some may be as important or more important than your score are (a) a patient's post-surgical pathology (positive margins? Gleason score? seminal vesical invasion? cancer in lymph nodes?) (b) was PSA undetectable or persistent after surgery or what was the nadir after radiation and/or what was the time to biochemical recurrence and (c) what is the PSA doubling time during biochemical recurrence.

I view DECIPHER as a way to help guide you towards the more aggressive or less agressive treatment option when you are on the fence about your options. Although some cancer patients in general are of the mindset, go as early and aggressively as possible despite what the studies say as long as your treatment strategy is within your tolerance for the physical and financial side effects. Some (mainly doctors) would term this overtreatment, others might term it playing it safe. This score would be something to consider in deciding which direction you want to lean.

I think in most cases, post-RARP this would primarily be used to help inform your MO regarding the extent to which they recommend doing ADT in conjunction with Salvage RT. If all your other factors were say "Intermediate Risk" having a bad DECIPHER score may make it prudent to consider yourself High Risk which might translate to doing 24 months of ADT intstead of 6 for example. And/or doing whole pelvic radiotherapy in stead of just to the prostate bed. Both of which have been shown to increase time of survival in High Risk Patients I believe.

FYI. Here's the info about DECIPER.

The Decipher score, also known as the Decipher Prostate Cancer Classifier, is a genomic test that helps predict the risk of metastasis and prostate cancer-specific mortality after radical prostatectomy. The score is based on the expression levels of 22 RNA biomarkers in the patient's prostate tumor tissue. These biomarkers are involved in multiple biological pathways associated with aggressive prostate cancer behavior.

The Decipher score takes into account the following factors:

Androgen signaling: Genes related to androgen receptor signaling and responsiveness to androgens.

Cell cycle progression: Genes involved in cell cycle regulation and proliferation.

Cell adhesion and motility: Genes associated with tumor cell adhesion, migration, and invasion.

Immune response: Genes related to the immune system's response to the tumor.

Stem cell biology: Genes involved in stem cell-like properties and pluripotency.

The expression levels of these 22 biomarkers are measured using a high-density oligonucleotide microarray platform. The resulting Decipher score ranges from 0 to 1, with higher scores indicating a higher risk of metastasis and prostate cancer-specific mortality.

[jazj in reply to jazj]

Note this is an expensive test unless you have good insurance that covers it. If you had several other high risk factors that is leading you down an aggressive treatment path already, does anyone know if this has significant usefulness in that context? That is, if you are already planning to "throw the kitchen sink" at the cancer, what benefit would the test provide?

[maley2711 in reply to jazj]

exactly...little benefit for men already high risk...though a few will have scores that are more encouraging!!

[Elbers123]

My doc was using to help measure how much to radiate and whether to include ADT. I think I originally heard it through the SSport trial that TA brought foward. It carried enough weight that he ordered it and it changed my treatment plan. I agree it’s only a part.

[Fred312]

The recurrence risk the Decipher after RP test predicts changes with time. The risk is front loaded, mostly in the first two years after surgery. People with high risk scores (like me I just found out), fail RP quicker than lower scores, but a plus(lemons to lemonade ) is if you make it without BCR a few years much of the recurrence risk is over. It's all statistics though so no guarantees. It reminds me of womans triple negative breast cancer. It's a worse cancer with faster relapse but if you make it 3 years without recurrence the risk from that point is less than a woman with the hormone sensitive versions.