Decipher question

[gualala]

First post. Age 67. Unfavorable intermediate PCa. 4+3 in 4 cores/20; 3+4 in 6 cores/20. Simple cribriform. Some PI in 2 cores. PSMA pet scan shows no evidence of meta. .66 Decipher score.

Decipher says that with this score, I have an 8.6% risk of metastasis in 10 years if treated with RT or RP, so ADT or another modality is recommended.

So, by my math, this means that I have a 91.4% chance of no meta in 10 years if I don't do ADT (or another modality).

But Decipher, which focuses on various statistics, doesn't say what the improvement would be with ADT. Does my chance of meta go down significantly by adding ADT?

[Tall_Allen]

Please re-read your Decipher report. I think it says that you have a chance of 8.6% within 10 years if NOT treated.

[gualala in reply to Tall_Allen]

The Decipher report says "this patient has a predicted 8.6% 10-year risk of metastasis with radical therapy (e.g. radical prostatectomy or radiation therapy)..." It also says I have a 3.4% risk of meta in 5 years and an 11.3% risk of PCa mortality in 15 years with RT or RP..

"These patients may benefit from treatment intensification with multimodal therapy."

"Ninety percent of radiation oncologists recommend the addition of ADT to radiotherapy when the 10 year risk of metastasis is greater than or equal to 5%."

My point is that Decipher gives very precise % except regarding the benefit of ADT, that is, how much reduced risk results from adding ADT? It just says I may benefit, but not by how much.

[Tall_Allen in reply to gualala]

What it is telling you is that you have an 8.6% risk of having occult metastases now that will become detectable within the next 10 years. If you have radical local therapy, you won't kill them, but if you have adjuvant ADT with radiation you stand a better chance.

[Bourbon2024]

The Artera test may give you more information relative to ADT therapy.