My only comment comes from my own personal experience. April of 2023 my 2nd MRI came back clean. In July my biopsy showed two cores out of 14 with cancer, one at 3+4. I decided immediately on an RP. After the RP, my pathology report indicated the cancer was actually 4+5 and near the capsule. I also had a decipher test which indicated a high risk of recurrence. I learned through my experience that the biopsy may not be accurate. Personally, I wanted the cancer removed. Hope this helps. Best wishes.🙏

@rice:
My Decipher score and the available 7 page GRID report were the deciding factors in my AS decision, after receiving a mpMRI fusion biopsy that produced 2 low volume cores of 3+4=7 (details in my profile).

The clinical-genomic model on page 2 of my GRID report was very helpful…even if “Research Only”…this IMHO is the future of where treatment decisions (for those with low volume 3+4 cores) for newly diagnosed PCa is heading.

Decipher was just given a “Level 1B Evidence” rating by the NCCN, at the end of February 2024.
https://www.urologytimes.com/view/decipher-prostate-test-receives-high-evidence-rating-in-nccn-guidelines#
There needs to be enough 3+4 in your core sample to perform the test. If all that was found in your 2nd biopsy was a tiny amount (2%) of 3+4 and one 3+3 (it wasn’t clear in your question explanation) then that could be why a Decipher test would not be requested.

If you only have one 3+3 core (assuming it was an mpMRI fusion biopsy) Cooperberg says he would definitely begin AS…no current active treatment recommended.

Here’s a great 15 minute video (Dr. Charles Ryan interviewing Professor Cooperberg) regarding when AS should and shouldn’t be recommended…also a very interesting take on focal therapy.
https://www.urotoday.com/video-lectures/asco-gu-2022/video/mediaitem/2557-risk-stratification-for-localized-prostate-cancer-matthew-cooperberg.html?utm_source=newsletter_10343&utm_medium=email&utm_campaign=prostate-cancer-daily

My doctor doesn't think much of the decipher test. He said I don't need it because I'm a Gleason 8, stage 3b. We are already know I'm very high risk.

rice:
There is no reason to not get the decifer test since they will use the biopsy samples that are already taken. I had my biopsy done, tested (Gleason 3+3=6) and a genomic test(low risk ) done at my local healthcare system. I felt uncomfortable with the doctors so I went to Mayo and had Mayo retest the samples. They came back 3+4=7 and intermediate risk of spreading. Go with the best, healthcare system adn tests and make your decisions from there.

All good advice. Absolutely get the Decipher test. I had the Prolaris test first but then had the Decipher test based on an RO's advice in New York City and my radiation oncologist in Florida, both said the sampling size is larger with the Decipher test.

Decipher is genetic. Called somatic testing it tests the tumor mutations. It is different from the hereditary testing, which can also be helpful.
Immunotherapy with specificity to each patient's tumor is intriguing.
I would want the testing in case of metastasis. I hope the information will never be useful to you. You have been through enough already.
But it may help you with vigilance and with a determination about future ADT. Plus you'll be contributing the the knowlege that may someday make prostate cancer powerless.
https://decipherbio.com/decipher-prostate/physicians/grid/
Glad you are well.