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Radiation vs RARP for IDC prostate cancer with high Decipher?

Posted by mlabus3 @mlabus3, Apr 6 5:57pm

70 years old, fit. PSA is 5 and slowly rising. Gleason 3+4. PIRADS 4. Localized. Clean PET. BUT, Biospy showed 6 positive cores - extensive left side cancer and "extensive" interductal present in 3 biopsies. Plus, my Decipher is .98. Scary.

Sadly, I cant seem to get any meaningful answers from my surgeon or oncologist on how this impacts my treatment. Do these factors push me to one treatment vs the other? I get a lot of "we look at the PSA and Gleason", but get no real feedback on what I to look forward to! I am guessing that post-surgery pathology might give me a clearer picture of the road forward, and if any further measures are required. I am worried about a recurrence given the Decipher score and the more aggressive interductal. Maybe there is something about radiation that makes it better or worse, i cant put my finger on anything. But if recurrence is likely, that shifts the decision paradigm to surgery.

Am filled with anxiety and struggling with a decision. I was ill for 4 months after my biospy with an unrelated condition, so 7 months have gone by since my biopsy. Any thoughts would be appreciated. Need to make a move! Thanks.

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mlabus3 | @mlabus3 | Apr 17 2:00pm
In reply to @mlabus3 "unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i..." + (show)
Profile picture for mlabus3 @mlabus3

unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i have IDC-p present in 3 cores and Decipher score of 98.

Im looking for an aggressive treatment plan, but just getting standard treatment options. One recommendation is to skip the RARP altogether and go straight to hormone/radiation. I gotta believe yanking that thing out is step one. Also, i see early studies that show that IDC doesnt always respond well to hormone/radiation. it appears that there IS no aggressive treatment option for IDC, and a lot of early work is going into trying to identify better treatment options.

Anyone who has any similar experience and/or intelligence they can share would be greatly appreciated.

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how do you know that your husband foes not have yhe "inherited mutations"?

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robertov | @robertov | Apr 17 6:10pm
In reply to @mlabus3 "unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i..." + (show)
Profile picture for mlabus3 @mlabus3

unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i have IDC-p present in 3 cores and Decipher score of 98.

Im looking for an aggressive treatment plan, but just getting standard treatment options. One recommendation is to skip the RARP altogether and go straight to hormone/radiation. I gotta believe yanking that thing out is step one. Also, i see early studies that show that IDC doesnt always respond well to hormone/radiation. it appears that there IS no aggressive treatment option for IDC, and a lot of early work is going into trying to identify better treatment options.

Anyone who has any similar experience and/or intelligence they can share would be greatly appreciated.

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I didn’t see you say that you had a PSMA-Pet Scan? That will tell you a lot about your cancer, and its spread. Without that, I don’t see how you can decide on your options. If it has spread widely, you might need more systemic choices.

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mlabus3 | @mlabus3 | Apr 17 6:41pm
In reply to @mlabus3 "unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i..." + (show)
Profile picture for mlabus3 @mlabus3

unfortunately, i while i have a PSA of only 5, 3-4 Gleason, and localized cancer, i have IDC-p present in 3 cores and Decipher score of 98.

Im looking for an aggressive treatment plan, but just getting standard treatment options. One recommendation is to skip the RARP altogether and go straight to hormone/radiation. I gotta believe yanking that thing out is step one. Also, i see early studies that show that IDC doesnt always respond well to hormone/radiation. it appears that there IS no aggressive treatment option for IDC, and a lot of early work is going into trying to identify better treatment options.

Anyone who has any similar experience and/or intelligence they can share would be greatly appreciated.

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clean pet scan.... whew

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surftohealth88 | @surftohealth88 | Apr 17 8:48pm
In reply to @mlabus3 "how do you know that your husband foes not have yhe "inherited mutations"?" + (show)
Profile picture for mlabus3 @mlabus3

how do you know that your husband foes not have yhe "inherited mutations"?

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He sent his sample here : https://www.prostatecancerpromise.org/

It took about 3 weeks to get results back.

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surftohealth88 | @surftohealth88 | Apr 17 8:49pm
In reply to @mlabus3 "clean pet scan.... whew" + (show)
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clean pet scan.... whew

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That is great : ))) !!!

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jeff Marchi | @jeffmarc | Apr 17 8:49pm
In reply to @surftohealth88 "Yes, thanks Jeff for posting the link , I read that one too. There are subgroups..." + (show)
Profile picture for surftohealth88 @surftohealth88

Yes, thanks Jeff for posting the link , I read that one too.

There are subgroups of cribriform formations and depending of pattern the risk is different. There is also IDC-P difference between 2 IDC patterns with different predictions. My husband has none of inherited mutations.

I will concentrate on those studies that show less risk for him according to his particular pattern ; ). (Knock the wood)

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What I heard was if the cribriform was larger than .25 mm it was more aggressive.

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surftohealth88 | @surftohealth88 | Apr 18 1:07pm
In reply to @jeffmarc "What I heard was if the cribriform was larger than .25 mm it was more aggressive." + (show)
Profile picture for jeff Marchi @jeffmarc

What I heard was if the cribriform was larger than .25 mm it was more aggressive.

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Hi Jef : ),
What I found in papers is that it is more about formation and type of cribriform glands. If the pattern presents as "poorly formed / fused glands" it is LESS aggressive than "large , irregular cribriform glands. The term of "poorly formed / fused glands" was exact wording in biopsy report and I could not believe my eyes- had to re read it about 10 times to make sure I am really seeing what I was seeing . I read about 50 articles about cribriform and IDC and this was the only one that went into such detail and it is the newest one (2024 , Urologic Oncology), I had to pay for it but it was worth it. In different article I found out that IDC also has 2 types : so called 1 and 2 type.. IDC 1 has almost the same predictions as non IDC. IDC-1 has loose cribriform present and IDC2 solid and dense cribriform. I mean , I am holding onto straws here, I know, but a straw is better than nothing ; ).

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cher60 | @cher60 | May 7 12:04pm
In reply to @robertov "I didn’t see you say that you had a PSMA-Pet Scan? That will tell you a..." + (show)
Profile picture for robertov @robertov

I didn’t see you say that you had a PSMA-Pet Scan? That will tell you a lot about your cancer, and its spread. Without that, I don’t see how you can decide on your options. If it has spread widely, you might need more systemic choices.

Jump to this post

Hi, my husband had 2 PETCT scans and neither showed the location of his metastasis, he is one of the minority who unfortunately don’t react to the radioactive material. Eventually he was put on hormone therapy to give a flare up and it was then found on a CT scan in his rib.

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edwardbrown1 | @edwardbrown1 | Dec 3 2:14pm

in reply to @mlabus3 "Radiation vs RARP for IDC prostate cancer with high Decipher?
I feel your anxiety because my Decipher Prostate score is 0.92 placing me in the 98 percentile for risk. I suggest that all have their urologist or oncologist request from Veracyte the Decipher GRID report. (I have not seen this suggestion mentioned so far.) It's a "Research Use Only" report, so should be considered with that understanding. But it could give much more background information on the aggressive nature of your cancer cells. To quote the report, " Decipher GRID contains RNA expression values covering 46,000 coding and non-coding genes..." The data is distilled down in 3 ways: a genomic atlas of 30 genomic signatures, a gene expression list of 60 genes/ signatures organized into 10 biological modules, with a percentile ranking for each gene, and grid expression matrix (e.g., heat map). It's an avalanche of information. I've seen YouTube videos, i.e., Ashley Ross, MD, PhD, to help understand these reports. Good luck.
And thanks to all for so many useful and meaningful comments!

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