Why are urologists dismissive about Decipher?

As far as ADT use the Arterra AI platform is more instructive, Apparently 2/3 do not benefit from it as an add onto radiotherapy. 37% do benefit from its add on use. This test is predictive and prognostic. Decipher is based on a genomic platform that is prognostic.

I have read that the problem is the application of the score to historical data supplanted by newer metastatic risk technology assessment methods, e.g., dye enhanced multiparametric MRI (mpMRI) and PSMA PET/CT scanning. These two and the Decipher score may provide a more sanguine context to the previous
Gleason scoring only. Add to them the tumor size and or its changes over surveillance periods, and other criteria easily susceptible to new Artificial Intelligence derived algorithm correlations in the near future.

heavyphil,
all prostate surgeons are urologists. There are urologist who also perform prostate surgery. There are many urological surgeries aside from prostatectomy. "Most urologists are"surgeons."
Most urologist are not Surgical Oncologists.
The Surgical Oncologist at USC, who did not perform surgery in this case, insisted on two months of ADT prior in order to reach the "sweet spot." Even though the surgery removes the entire prostate. The prostate bed remains with some risk of biological recurrence.

This doesn’t make any sense. The decipher test is used after cancer is found. It is not to determine whether or not active surveillance would work. The PSE test is something you use to figure out whether there is cancer there yet, and to pick AS and avoid a biopsy if it shows nothing.

I suppose if you had a person with only one or two Gleason 3+4 cores, A very low decipher could decide to go on active surveillance, But the test is More designed to figure out whether or not you’re going to have something come back soon after treatment.

That’s the nature of machine learning algorithms. They are black boxes. Sometimes they layer ‘reasoning’ over the results but that’s really not an accurate assessment of what actually goes on behind the scenes.

Yes, several urologists told me exactly that. That decipher isused in 3+3 and 3+4 cases to decide on AS. I understand that with 4+4 it does not affect treatment decisions, but it should affect their assessment of recurrence risks.

Two years ago my urologist/surgeon suggested the Decipher test after my 3rd biopsy. I hadn't heard about it at the time. It was covered by (Original) Medicare.

I wasn't high risk. 1st biopsy was one core 3+3, less then 5%. The 2nd biopsy found no cancer.

It's possible that some Medicare Advantage programs might deny you. If that's your case, you can always contest it. In general 80% of contested MA denials are eventually approved.

I'm one of those persons. 1st biopsy was 3+3, 1 core, less than 5%. 2nd biopsy nothing. 3rd biopsy 3+4, 1 core, less than 5%.

My urologist/surgeon suggested sending the 3+4 in for the Decipher analysis. (And he's a bit on the aggressive side; i.e. he's suggested surgery a couple of times.)

Result, low risk so I'm still on Active Surveillance and plan to stay on it as long as I can.

Hey gently, a bit confused by your reply; is this your treatment involving ADT? Someone else? Either way, surgery was employed as primary treatment, no?. Don’t see any mention of Decipher used to find the “sweet spot” you mention, although we’ve discussed the pros and cons of shrinking the gland prior to surgery.
Phil

Gleason 3+4 is borderline (the lowest result they usually refer to as "cancer" these days) — that's where something like Decipher is most useful, as a sort-of tie-breaker vote for choosing between more or less intervention.

As @jeffmarc mentioned, once you're up to Gleason 8 or 9 ( or actually metastasised), there's no longer any doubt that the cancer is serious and needs major intervention, with or without a Decipher test.

Thanks for your comment, @breadmaker . My biopsy was done in late January. My urologist in the regional hospital referred me to a Cancer Center medical oncologist and radiation oncologist. I was seen by both the MO and the RO in February but neither mentioned Decipher. When I chose SBRT in March, I asked the RO about Decipher. I now think that at that point, if the RO decided in favor of Decipher, it would have been difficult to obtain my two-month tissue samples from the regional hospital. Perhaps my urologist should have ordered Decipher as a soon as he got my pathology report Gleason 7 (3+4), positive on 8 of 14 cores. It was missed opportunity, I was advised to focus on choosing what treatment I like: open surgery, robotic-assisted radical prostatectomy, or SBRT. Two months passed by before I chose SBRT, that I completed on month 3 after my diagnosis. I hope this discussion will help newly-diagnosed members of this support group to ask about Decipher right away, or as soon as he is researching on the menu of treatment methods.