Am I candidate for AS?

[Piano777]

66 year old, Dx January 2022

PSA peak 5.76

Biopsy 3/15/22

3 of 14 cores PCa

1 of 4 cores, 4+3, 80% Gr 4, <5% of tissue, left posterior

2 of 2 cores, 3+4, 20% Gr 4, 20% of tissue, left mid

Decipher .34, cut off for low aggression is .45

NanoKnife June 6, 2022

PSA nadir 1.21

Biopsy 5/16/23 original

Ablated areas clear

2 of 14 cores PCa

1 of 2 cores, 3+4, 20% Gr4, 7% of core, Right base posterior

1 of 2 cores, 4+3, 70% Gr 4, 15% of core, Right apex posterior

Biopsy 5/16/23 Johns Hopkins regrade

Ablated areas clear

2 of 14 cores PCa

1 of 2 cores, 3+4, <5% Gr4, 10% of core, Right base posterior

1 of 2 cores, 3+4, 30% Gr 4, 30% of core, Right apex posterior

Decipher .17, cut-off for very low aggression is .20

PSA currently: 2.3

Am I a candidate for AS?

Are the other genomic tests (Prolaris or Oncotype) better at making AS decision?

Has anyone with Medicare been able to get them to pay for a different test after already paying for one?

Thanks

[Tall_Allen]

No, IMO you are not a candidate for AS. 30% Grade 4 for is too high.

I think Decipher is the one with the most validation, but it really doesn't matter what a genomic test says when you have that much pattern 4.

Here's an article discussing some alternatives:

prostatecancer.news/2018/10...

But I have no idea what side effects you can expect after Nanoknife treatment.

[Piano777 in reply to Tall_Allen]

Thanks for quick response and link.

[TheHatboxGhost]

That's a question for your doctor(s). But I would think not. 3+3 is usually the AS cutoff.

[groundhogy]

Here is a good website to compare odds of cure for the major treatment paths. You have to determine your stage, low risk, intermediate, or high risk (risk of recurrence). So if you are intermediate, pull up the intermediate chart and you can see the odds of 10-20 yr survival, etc. based on the treatment you pick.

prostatecancerfree.org/comp...

It is best viewed on computer or just print it on paper. Not so viewable on phone.

To make the graphs easier to read, i drew a dot on the endpoints of the elipses, and then drew a line through the dots. This turns the elipses into lines.

Also be aware the the graphs don’t show any salvage radiation benefit. This would boost the surgery odds up a bit.

Also beware, this is a very dysfunctional industry from my view. Loads of bad info mixed in with the good info. Same with the docs. Some of them are more dangerous than the cancer.