Decipher test

My urologist ordered the Decipher test. I assume it was after the biopsy came back positive but not sure - I received both results at the same time. Decipher results may help you decide between prostatectomy and radiation.

I'm not a medical professional and don't really know what's common in the industry. But I do know that when I had a prostatectomy at Mayo Phoenix 06/2024 no decipher test was performed afterwards. So I suspect that's not a recommended guideline or Mayo would probably be doing it. Of course normally the decipher test is done before to help guide treatment decisions. In my case I have a terrible family history of aggressive prostate and breast cancer so I felt surgery was the best option for me. Of course after surgery since they have the prostate in the lab the pathology report reveals a lot. In my case, the bad news was the pathology report disclosed I had cribriform and IDC present (which hadn't showed up on my pre-surgery biopsy). But the good news was all the margins were clear so I'm hoping it was entirely local to the prostate. In my case with cribriform and IDC present I know if it comes back I'll have to treat it aggressively. I'll be interested to hear what others say on this thread. Maybe I should have requested the decipher test after the surgery just to have more information in case it does come back; I don't know. Best wishes.

It’s really upon you to get that decipher test. There’s more than one test that could be done, some doctors want to do the Arteria Ai test or another one of the available tests. Some other places will not do the decipher test at all.

You need to speak up sometimes and say what you want.

@johndavis60
Per the guidance of my urologist and R/Os Decipher test are usually done after a biopsy Gleason score. It helps determine the risk level of your specific cancer and guide the urologist or R/O best treatments for you.

I am a proponent of Decipher tests due to my personal experience with it. When I had my MRI/Fusion biopsies it came back the worse at 3+4=7 and the rest at 3+3=6. The R/O put me at intermediate risk and my treatment plan was radiation and hormone treatment.

I was not on MCC at that time (January 2023) and had no idea what a Decipher test was. My Mayo R/O suggested we do a Decipher test and bone scan. The Decipher test came back as low risk. Thus my treatment plan was changed to radiation only no need for hormone. The Decipher test changed my treatment plan and I was very glad did not have to do hormone treatments.

I went on to get a second opinion at UFHPTI. They wanted another test called PSMA done which I did and was negative. UFHPTI concurred with diagnosis of Mayo and treatment plan was 30 rounds of proton radiation. I went with proton radiation for the possiblity of reducing radiation damage of photon radiation to surronding organs and tissues as photon goes out through body which proton can be progammed to stop a specific spot and not exit the body.

Photon was all that Mayo Jacksonville could offer (Mayo Jacksonville is building a new cancer center with proton radiation opening in 2026).

Thanks!
I will ask about that.
They told me that I am high-risk and I have already chosen surgery as my treatment. What else can the Decipher test tell me?

Thanks @retireditguy
Your situation seems similar to mine although my surgery is not until May.
I know I’m high risk as a result of the biopsy, so if mine comes back after surgery then I guess they will recommend radiation?? I do hope to stay away from ADT drugs - people here say lots of bad side effects. OTOH I would rather deal with side effects than having this spread around.

There are a couple of Genomic testing companies out there. Mine was Decipher, which gives you a risk estimate of metastasis after treatment, at intervals of 5 and 10 years. Also gives a risk of "prostate cancer mortality" at 15 years. As others have said, the test is requested by the treating doc. Good luck going forward!

Just to be clear, you can get the genomic testing after a biopsy before any treatment, which can sometimes help decide which treatment, if any is appropriate.

It shows how likely you are to have a reoccurrence soon. If you are a Gleason 9 or 10, you already know that you are likely to have a reoccurrence, So it makes less sense to get the Decipher test. If you also have cribriform it can increase the likelihood of reoccurrence. The same is true If the cancer got out of the prostate..

Here's an interesting talk that another member posted on another thread. It's full of good info.
For my specific case (surgery and now monitoring psa) the key piece I took away is that with PMSA imaging, if the PCa reoccurs and radiation is chosen there's differing opinions on how and when to radiate (assuming radiation is selected). Long story short, if mine comes back I'm going to take enough time to get several expert opinions from CCOE's before deciding on how to treat the reoccurrence. Of course, hopefully it won't come back for either of us. Best wishes.