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.
I would make the same decision. Quality vs Quantity at the age of 78. You are fortunate to have all this data to make an informed decision. March on Sir!
We all have are concerns about treatment options, but you appear to be ignoring data points that do not fit your already developed decision. thedecisionlab.com/biases/c...
That is your choice, but you should be aware of it. And frankly, at 66 yo I had 18 months of ADT, was glad I did, and consider the side effects a mild nuisance. Good luck which ever way you decide.
OH!! And I just noticed you are so young! That would INCREASE my concern and tip it to doing ADT.
Hmm. Isn't paying out of pocket for Artera to tell me if I can benefit a sign that I acknowledge my own bias against ADT and want an independent third party to tell me if I could benefit? Artera is in the business of using its technology for people like me. Yet even though I have sought out tests from both Decipher and Artera you say I am making a decision based on my internal bias. Why are in Decipher and Artera in business and acknowledged in the medical community if they are to be ignored?
Tall_Allen ,
I appreciate if you can advise if there are alternatives to Artera test as I have been waiting for Artera test results too (Fox Chase now sends slides to Artera). Is there a different test to predict "biochemical failure is a more important endpoint"?
Yes, that's what NCCN risk groups and the therapies developed for them are for.
Hola TA. Your comment that those who expect to die of old age in the next 15 years don't need hormone therapy called my attention. At 79 years old, would I be among those not needing hormone therapy, or am I taking your comment out of context?
You can decide based on this:
webcore.mskcc.org/survey/su...
Remember, bone metastases are painful and crippling.
Thank you, TA.
Just to understand, if someone is 75-80, and RT + ADT is the Doc's advice, ADT of questionable benefit? Source for that? I have seen that 12 mo ADT added to RT for unfavorable intermediate/high risk PCa provides most of the ADT benefit, compared to 24 months?
If you go the Orgovyx route and find the SE's unbearable, you can stop and quickly recover. That's what I did and found the SE's to be a pain, but not enough to not continue for 6 mos.
I read you first post and now this one. Sounds like you made a decision so why are you wanting to rehash it.
Ask about Nubea monotherapy.
AI and Prostate Cancer
Brachytherapy
Terminate ADT after 1 year or continue for 6 more months?
Intermittent ADT
