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Prostate Cancer | Last Active: Aug 21 7:59am | Replies (12)

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Thank you for your response. I mentioned the decipher to the radiologist, but it wasn’t addressed. Is that an analysis of the biopsy? He did have the PSMA which showed no metastasis. Our health insurance is Kaiser of Northern California. They will not refer out for a 2nd opinion to a center of excellence. The Surgeon we saw is a Surgical Urologist Oncologist. My husband made the decision to have it out vs radiation and the surgeon said that it is easier to do salvage radiation after the surgery then it is to do surgery after radiation as there will be scar tissue to remove from radiation.

Would a decipher give us any additional useful information? The intraductal on its own is what has tipped this to be considered aggressive. Also, in hindsight I wish things had moved quicker because of the sheer volume of positive cores.

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Replies to "Thank you for your response. I mentioned the decipher to the radiologist, but it wasn’t addressed...."

Yes, Decipher is a genomic test on the most aggressive biopsy core. It gives you sn estimated risk of future metastases. It can usually be done quickly. Check out their website. Veracyte (the owners of the decipher test) has an Access Program that offers affordable rates for patients whose health insurance does not cover it.

If I understood you correctly, they will do RT+ADT shortly after surgery. After that, there are no further salvage options, so the point that you can always do RT after RP, but not vice-versa, is moot imho. I would definitely talk to a radiologist. For aggressive cancer they will likely suggest the inclusion of a brachytherapy boost, that is a high dose internal targeted radiation of the prostate. By my reading of the literature it is almost as effective as RP and has far fewer side effects that RP+RT in short order. The internal lesions need years to fully heal and putting radiation on top after a few months can result in permanent incontinence and guaranteed impotence.

@sjorgie
I see you posted to @topf but wanted to give you my personal experience with this and the importance of Decipher test was for me.

When I had my consultation with Mayo R/O and we went over treatments it was radiation and hormone treatment because my biopsies risk were listed as intermediate.

He suggested Decipher test and bone scan. Bone scan came back negative. I chose to get Decipher and Medicare paid for it. Note: Decipher will help reduce cost and payment plan if your insurance turns it down.

My Decipher test came back low risk not intermediate. That changed my treatment plan from radiation and hormone to radiation only. After all I read and saw posted about hormone treatments I was very glad to get that news.

So you can see I am alway promoting Decipher test. The test uses existing biposies. I had 30 rounds of proton radiation at UFHPTI. I did so because I wanted proton not photon which Mayo Jacksonville had not proton. UFHPTI also did a PSMA and it also came back negative.