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Where are all the people on Active Surveillance (AS)?
Prostate Cancer | Last Active: Oct 26, 2025 | Replies (59)Comment receiving replies
@handera Thanks for the reply and question: I didn't get my Decipher Score until after my RP surgery. When I asked about it, my urologist said that he had tried to order it, but my "insurance company" denied payment coverage for it. I had both my wife's PPO plan AND I was on a Medicare Advantage Plan. I quickly called my Medicare Advantage Plan and they instantly said: "yes, you are fully covered for the test...there is no pre-authorization required. I was PISSED OFF at my urologist. I was completing a divorce so I was no longer on my wife's PPO plan (I was/am retired), so I couldn't check her plan, but I directly asked my urologist: "WHY didn't you check with Medicare?" He literally didn't answer, but instead answer with: "We know everything we need to know now that we have the surgical pathology report." I said "no we don't...I know nothing of my genetic make up and any genetic markers that make me predisposed for a worse or better outcome. I demanded that he order the Decipher test. My score was dead on in the middle at .50 "Intermediate Risk", but...my genetic profile was such that I have very low probability of death in 5, 10, or 15 years. The worse risk is like 7% at 15 years. I actually see him "tomorrow" and we're going to have a "chat." He is an incredibly nice guy and competent surgeon, but he is a bit dismissive and cavalier when considering his patient's opinions...or at least "my" opinions. He has never been fond or tolerant of my more educated and pointed questions (I was in health care for 40 years). And...
I regret to say that I have no idea what PSA Density is, nor high PSA velocity. That is not even in Dr. Walsh's book that I recall. Please explain what they are and what they mean. Thanks
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@rlpostrp
Interesting about your experience regarding Decipher…I also had to ask my urologist to obtain mine, which he did.
I was also on a Medicare Advantage Plan, which paid the entire cost.
I did have to pursue the Decipher GRID report myself (directly with Veracyte)…I’m glad I did as it provided very valuable information (from my POV) that helped confirmed my AS decision.
My understanding is that Decipher can also help to understand one’s risk for metastasis after RP, so that may be useful information in your situation.
PSA density (PSAD) is your PSA level (ng/mL) divided by your prostate volume (cc); which is determined in a mpMRI. Did you obtain a mpMRI prior to your biopsy?
PSAD helps differentiate elevated PSA due to cancer from that caused by benign prostate enlargement (BPH)…ideally you’d like to be less than 0.15, while numbers greater than 0.20 could mean a higher likelihood of a more aggressive cancer.
PSA velocity measures the rate of change in PSA levels over time. It requires at least three PSA measurements over 18 months.
A yearly PSA rise greater than 0.75 ng/mL or more than 25% per year can indicate a higher potential for a more aggressive cancer.
None of these biomarker measurements (by themselves) are definitive; but taken together with Gleason and Decipher scores, allows doctor and patient to put together a more complete picture of the true aggressiveness of a man’s particular PCa and all the treatment (or AS) options that would be available in a particular case.
A lot more could be said, but I’ll stop here….