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Did Decipher GRID report help guide your treatment decisions?

Posted by handera @handera, Jan 11 5:18pm

I'm 67 years old with a prebiopsy PSA of 7.8, three mpMRI PIRADS lesions of 3, 4, & 5 and my MRI fusion biopsy found 5 cores of very low volume 3+3 and 2 cores of low volume Gleason 3 + 4, out of 15 cores. I was considering Active Surveillance (AS) and requested a genomic test. My urologist suggested Decipher. My doc gave me the standard 3 page Decipher "Patient Report", which was helpful, but someone in this support group suggested obtaining the more detailed Decipher GRID report.

I called a Decipher representative and received my GRID report, in 15 minutes, by email - and am I glad I did! My diagnosis was "borderline" for AS, so the additional GRID information helped to confirm this treatment decision. Page 2 of the GRID report includes an easily understandable "Clinical-Genomic Risk Model" (see attachment). Essentially, the combined model helped to confirm that AS is a viable choice for my diagnosis and my urologist agrees.

Has anyone obtained both the Decipher "Patient Report" and Decipher GRID report? What was your experience with the usefulness of this information and did it influence your treatment decision?

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gently | @gently | May 5 10:25pm
In reply to @rice "My first biopsy they found 3+4 in less then 2% of one core that was on..." + (show)
@rice

My first biopsy they found 3+4 in less then 2% of one core that was on 2021 the sample was to small to get a decipher test. I changed doctors and he’d did a transperineal biopsy no change in the one core but they found another core 3+3 in less then 25 % of one core. My doctor does not think much ov decipher test. Should I insist I get one it would be reassuring that I am doing the right thing by watchful waiting.

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Rice, I'd be worried if my doctor didn't think much of the decipher test. But I forgot to mention that the decipher results report is about 28 pages long. But you have to ask for the "grid" Otherwise you'll receive a simple 3 pages about risk. It is probably better to call Decipher to ask for the full report. https://decipherbio.com/decipher-prostate/physicians/grid/

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toolbelt | @toolbelt | May 5 11:12pm
In reply to @rice "My first biopsy they found 3+4 in less then 2% of one core that was on..." + (show)
@rice

My first biopsy they found 3+4 in less then 2% of one core that was on 2021 the sample was to small to get a decipher test. I changed doctors and he’d did a transperineal biopsy no change in the one core but they found another core 3+3 in less then 25 % of one core. My doctor does not think much ov decipher test. Should I insist I get one it would be reassuring that I am doing the right thing by watchful waiting.

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The Grid report is " For Research Use Only" and not necessarily used for diagnosis, staging or treatment.

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gently | @gently | May 6 12:24am
In reply to @rice "My first biopsy they found 3+4 in less then 2% of one core that was on..." + (show)
@rice

My first biopsy they found 3+4 in less then 2% of one core that was on 2021 the sample was to small to get a decipher test. I changed doctors and he’d did a transperineal biopsy no change in the one core but they found another core 3+3 in less then 25 % of one core. My doctor does not think much ov decipher test. Should I insist I get one it would be reassuring that I am doing the right thing by watchful waiting.

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Information from the grid let me know that the tumor was androgen active, glucose active by which and how much each gene was implicated. It will tell you how active your immune system is. A little further research can tell you which genetic mutations have proven susceptible to which chemotherapeutic agents. And could clue you in to which clinical trial might likely benefit you. It can tell you if metformin or statins would likely benefit you.
The decipher score "is determined solely by the genomic characteristics of the tumor" itemized on the Grid labled "Research Use Only."

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1 reply
jc76 | @jc76 | May 6 5:55am
In reply to @rice "I asked about the 3+ 4 and was told it was very small and it just..." + (show)
@rice

I asked about the 3+ 4 and was told it was very small and it just barely a 7

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rice
Look at reply from robertmizek.
If you had a 3+4=7 in one area regardless of size probably have other areas that have this with same degree that MRI can miss and biopsies do not take tissue from all areas of prostrate. When you move from 3+3=6 to 3+4=7 you move from low risk to intermediate risk.

It is why both Mayo Clinic and UFHPTI were and did treat my entire prostrate to ensure all areas were treated.

If you read about hormone treatments it dose not kill but inhibits the growth of the cancer cells that feed off testostrone. The standard treatment is radiation with hormone treatments. Don't be a standard treatment patient. Know all that you can about your cancer, the test available, and the different types of treatment specifically for what is best for you not be treated as a number. .

If me, and that is all we can give you as suggestions, I would want the Decipher test to more accurately give you a better diagnosis? I do not know who is treating you but Decipher tests are recommended at Mayo Clinic to get better diagnosis of risk and treatments. Mayo is one of the most outstanding clinics treating prostrate cancer.

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toolbelt | @toolbelt | May 6 7:49am
In reply to @gently "Information from the grid let me know that the tumor was androgen active, glucose active by..." + (show)
@gently

Information from the grid let me know that the tumor was androgen active, glucose active by which and how much each gene was implicated. It will tell you how active your immune system is. A little further research can tell you which genetic mutations have proven susceptible to which chemotherapeutic agents. And could clue you in to which clinical trial might likely benefit you. It can tell you if metformin or statins would likely benefit you.
The decipher score "is determined solely by the genomic characteristics of the tumor" itemized on the Grid labled "Research Use Only."

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Again, the possible outcomes from the "GRID" are not yet accepted as proven through randomized studies. I would not be at all surprised if the Grid gains the same acceptance as the Decipher score does, I do agree that any nugget that can be dug out of the GRID may be contributory to treatment decisions, but at this point the GRID is not yet validated.

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gently | @gently | May 6 8:28am
In reply to @rice "My first biopsy they found 3+4 in less then 2% of one core that was on..." + (show)
@rice

My first biopsy they found 3+4 in less then 2% of one core that was on 2021 the sample was to small to get a decipher test. I changed doctors and he’d did a transperineal biopsy no change in the one core but they found another core 3+3 in less then 25 % of one core. My doctor does not think much ov decipher test. Should I insist I get one it would be reassuring that I am doing the right thing by watchful waiting.

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toolbelt, where do you think Decipher finds the information to determine your score. Do you expect that your Decipher score is proven fact. The decipher score is the nugget dug out of their Grid.

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1 reply
toolbelt | @toolbelt | May 6 9:41am
In reply to @gently "toolbelt, where do you think Decipher finds the information to determine your score. Do you expect..." + (show)
@gently

toolbelt, where do you think Decipher finds the information to determine your score. Do you expect that your Decipher score is proven fact. The decipher score is the nugget dug out of their Grid.

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Simply reporting what is in the literature.

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bens1 | @bens1 | May 6 12:34pm
In reply to @rice "My first biopsy they found 3+4 in less then 2% of one core that was on..." + (show)
@rice

My first biopsy they found 3+4 in less then 2% of one core that was on 2021 the sample was to small to get a decipher test. I changed doctors and he’d did a transperineal biopsy no change in the one core but they found another core 3+3 in less then 25 % of one core. My doctor does not think much ov decipher test. Should I insist I get one it would be reassuring that I am doing the right thing by watchful waiting.

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Rice: I had the decipher test and it was used by all five of the radiation oncologists that I spoke with from either centers of excellence or with backgrounds from centers of excellence to make or change their diagnosis. I too, would question your doctor for not doing it. It is also a way to get another opinion which never hurts and will help you make a decision, in terms of the mode of treatment and aggressiveness level, as well as helping your doctors. All these doctors are making educated guesses.

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kjacko | @kjacko | May 6 3:54pm
In reply to @rice "My first biopsy they found 3+4 in less then 2% of one core that was on..." + (show)
@rice

My first biopsy they found 3+4 in less then 2% of one core that was on 2021 the sample was to small to get a decipher test. I changed doctors and he’d did a transperineal biopsy no change in the one core but they found another core 3+3 in less then 25 % of one core. My doctor does not think much ov decipher test. Should I insist I get one it would be reassuring that I am doing the right thing by watchful waiting.

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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.🙏

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handera | @handera | May 6 4:14pm
In reply to @rice "My first biopsy they found 3+4 in less then 2% of one core that was on..." + (show)
@rice

My first biopsy they found 3+4 in less then 2% of one core that was on 2021 the sample was to small to get a decipher test. I changed doctors and he’d did a transperineal biopsy no change in the one core but they found another core 3+3 in less then 25 % of one core. My doctor does not think much ov decipher test. Should I insist I get one it would be reassuring that I am doing the right thing by watchful waiting.

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@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

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