Decipher and Prolaris and Oncotype...oh my.

[TFU589]

In reading about the many uses of these genomic tests, it seems that there is a wide consensus/opinions on how they should be used for decision making. Looks like these tests can change how the prostate cancer is treated or not treated. Also, seems to be a wide consensus/opinion to go with ADT or not.

Would be great to hear from those that have these tests and how or if it has impacted their treatment.

[HaroldHG]

I’ve had the big three genomic test administered since my diagnosis in February 2020: (3) Decipher (1) Prolaris and (1) GPS.

Since I am riding the Active Surveillance Train in the “gray zone” area, I’ve used their results as tie-breakers on whether to still stay in the AS train or jump off towards treatment.

Some may say that it’s too much genomic testing but my medical insurance has covered the tests and I rely on them, especially Decipher.

All three genomic testing companies offer financial assistance with the insured and under-insured - with a max OOP of $250.00

I have also had the MiraDx Prostox done to assess my risk for developing Grade 2 or higher long-term urinary toxicity after prostate directed SBRT (my treatment decision when the time comes).

Best wishes on your journey.

[TFU589 in reply to HaroldHG]

Thank you for the response.

Would you happen to know your Decipher and Prolaris scores? Also, how did your docs classify your PCa? Low, Intermediate (Favorable or Unfavorable)?

[HaroldHG in reply to TFU589]

For Decipher, my scores were .18/.18 and .12 - for Oncotype DX GPS score of 15 and for Prolaris molecular score of 2.9.

I’ve been classified as Unfavorable Intermediate due to fact of having high volume G6 and a PSA hovering around 10-ish.

[Tall_Allen]

What decision are you trying to make?

[TFU589 in reply to Tall_Allen]

Trying to get more feedback on how other members here have had their genomic scores used when making a decision to treat or not to treat or go for another opinion. Although from my research, think I know what they are going to say.

Unfavorable Intermediate: greater than 50% positive cores (3+4 in one core from UCI and 3+4 in three cores from John Hopkins. Small amounts of 4.), PSA 3.5, T1C, PSAD .10), CAPRA 3.

Decipher: .18- Low (read one study where .2-.45, no problem with AS.

Prolaris Molecular Score: 4.1 (which pushes me over the border from AS and recommends one mode of treatment)

So it looks like I am on the low end of unfavorable intermediate, and if you take a look at the link below (Dr. Spratt et al), they seem to be looking at combining NCCN and genomics in to "Clinical Genomic Risk Groups".

pubmed.ncbi.nlm.nih.gov/291...

Just seem that I am in that gray zone that many of the docs talk about.

[Tall_Allen in reply to TFU589]

The small amounts of pattern 4 is really the key to your decision. There is little risk in waiting for GS4+3.

[TFU589 in reply to Tall_Allen]

Question 1:

What is your definition of "small amount of pattern 4"?

Have read many studies stating different percentages and the implications of those percentages.

For example, from one of Dr. Epstein's lecture slides.

3+4 =7 with 10% pattern 4. May be candidate for AS.

3+4 with close to 50% pattern. Not a candidate for AS

Also:

Also, stumbled upon another study that looked at the Total Length of the GG 4. Take a look if you have not read. (Stop the merry go round, I want off)

Clinical Usefulness of Total Length of Gleason Pattern 4 on Biopsy in Men with Grade Group 2 Prostate Cancer - PMC (nih.gov)

Question 2:

There is little risk in waiting for GS4+3. Can you clarify or expand on that ?

Thank you for your help.

[Tall_Allen in reply to TFU589]

It isn't just "percent of pattern 4" in each core, it's also the percent of those cores that are cancerous. In men who started with low risk PCa, there is little risk in waiting for at least significant presence of pattern 4.

clinical-genitourinary-canc...

[SimMartin in reply to TFU589]

I had g7 - 3+<10% 4 - PSA 4.1 - I opted for AS as MpMRI showed small and confined to one side.

Stayed same in biopsy and MRI 12 months later PSA 4.1

5 months later it took off and after failed HIFU it ended up with G9 4+10% 5 - so RT + ADT

Difficult decision but I think PCa is quite a slippery customer and any info helps but unless no pattern 4 I think treatment at some stage is inevitable. I maybe should have skipped the HIFU despite the biopsy and MRI stating still 3+4 and gone for the RT + Brachy and HT. The HIFU made brachy boost not viable in my case.

[TFU589 in reply to SimMartin]

Did you have any genomic testing done?

And yes, regarding the slippery slope, is definitely a concern of mine.

[SimMartin in reply to TFU589]

No I didn’t - enquired few months ago and told not necessary at this stage

[JolleySprings]

My husband’s Decipher score was .93… Very high risk. He has Gleason 8. Prostate removed 2017. All supposedly clear at the time. 6 months later, one Lymph lit up on Auxium scan. Had radiation… Decipher test showed probability of 3% radiation would work. It was correct. Radiation did not work. Next was ADT. After 4 years has become Castrate Resistant but still non metastatic. PTL. He had Foundation One Genomics Test… revealed rare Mutation CDK12. Also liquid blood biopsy. All of the info rendered from these tests has impacted his treatment plan! Cancer can mutate from one type to another. Our oncologist relies more on Liquid Blood Biopsies because of this. If the mutation morphs into another type, treatment plan may change. I believe all the genetic testing is a game changer!