From prior posts you might have gleaned I am struggling with the ADT decision. To solidify my final decision I had the Artera Prostate Test (artera.ai/for-patients) and I tested negative. This means I am unlikely to benefit from ADT. That coupled with my 0.40 low decipher has led me to the final decision to decline ADT.
Has anyone else done or have opinions about this test?
I, too, did the Artera.AI test and also tested "negative". That said, I still went through 6 months of Orgovyx ADT at the insistence of my MO, who knew nothing about the Artera AI test. But, my Decipher score was high, > 0.80, and I had Stage III PCa.
Gleason 4+3, plus suspicious spread outside of the capsule. Later, I was downgraded to unfavorable intermediate risk, based on MRI imaging.
can you share the findings that you based your decision on?
🔹 Age: 53
🔹 Diagnosis: Unfavorable Intermediate-Risk Prostate Cancer (Gleason 4+3=7, contested)
🔹 Pre-Treatment PSA: 6.8 ng/mL
🔹 Tumor Stage: T1c (Detected via biopsy, not palpable)
Imaging Results
MRI (Johns Hopkins, Dec 2024): PI-RADS 4 lesion in the right base of the prostate, possibly abutting the capsule.
PSMA PET Scan (Nov 2024):
Findings: Mild uptake in the midline posterior prostate near the base (SUV max 3.9).
No evidence of lymph node involvement or distant metastasis.
Interpretation: The PSMA PET correlates with the JH MRI lesion but does not show extraprostatic spread.
Biopsy Results & Pathology Discrepancy
First Biopsy (First Urology, Oct 2024):
Right Base: Gleason 4+3=7 (90% pattern 4)
Right Mid & Apex: Gleason 3+3=6
Left Side: All benign
Perineural Invasion (PNI): Present
Second Opinion (Johns Hopkins, Dec 2024):
Right Base: Upgraded to Gleason 4+5=9 (JH uses the most aggressive grade for the secondary score, rather than the second most prominent grade).
Right Mid: Gleason 3+4=7
Right Apex: Mostly Gleason 3+3=6
PNI: Present
Third Opinion (Indiana University, Jan 2025):
Right Base: Confirmed as Gleason 4+3=7, stating that 90% of the core is pattern 4.
Other Findings: Similar to First Urology, contradicting JH’s more aggressive assessment.
Final Biopsy Interpretation:
My first opinion pathologist stood firm on Gleason 4+3=7 even after reviewing Johns Hopkins' 4+5=9 diagnosis, leading me to seek a third opinion from Indiana University.
IU confirmed the 4+3=7 diagnosis, reinforcing the original classification.
Genomic Testing
Decipher Score: Low Risk 0.40 (3.6% chance of metastasis in 10 years).
ArteraAI Results:
ST-ADT Biomarker Negative: No clear benefit from short-term ADT with radiation.
Treatment Received
SBRT (ViewRay at UCLA, Jan 2025): 40 Gy to the prostate, with a 2 Gy boost to the dominant intraprostatic lesion (DIL).
No ADT (since ArteraAI showed no expected benefit).
Artera AI uses distant metastases rate as its endpoint. I think this is their mistake. It can take 15 or 20 years for a distant met to become visible on conventional imaging (which is what Artera AI is trained on) - that doesn't mean micromets aren't there! Once the cancer has distantly metastasized, it is too late to cure it.
IMO, biochemical failure is a more important endpoint for most patients. (If a patient is likely to die of old age or other illnesses in the next 15 years, he doesn't need hormone therapy.) Do you want to deal with metastases and the detriment to QOL as you age?
I appreciate that we all have different perspectives on ADT, but for me, the decision is clear. With a low Decipher score, a negative Artera biomarker, and having received 40 Gy to the prostate with a boost to the dominant lesion, I have resolved not to put my body through chemical castration.
I fully respect that some are willing to accept the side effects—weight gain, bone density loss, muscle atrophy, hot flashes, depression, cardiovascular risks, diabetes, and sleeplessness—for what amounts to a 10% increase in 3-year biochemical recurrence-free survival. But given my specific risk profile, the evidence suggests that ADT would not provide a meaningful benefit for me.
We all have different risk tolerances and priorities, and for me, avoiding unnecessary toxicity outweighs the potential marginal gain. I support those who choose ADT based on their own circumstances, but I’ve made an informed decision based on my genomic and clinical data.
ArteraAI Test
AI and Prostate Cancer
Brachytherapy
Terminate ADT after 1 year or continue for 6 more months?
Intermittent ADT
