Why are urologists dismissive about Decipher?

@service1010
You and I both have families with prostate cancer.

My father died at 88 from it.
I got it at 62 because my mother gave me BRCA2. Had RP then SRT 3 1/2 years later when it came back
My brother got it at 77. He was on active surveillance for about six years before that. Had RT

Overall, I would say you really have a good chance of having a long time without major problems, but that decipher score really surprises me. It must be the number of cores With 4+3 and 3+3 that got that score. Unless they found something in the samples, they got that were not seen in the biopsy you had.

13 years active surveillance is really a long time. Hopefully the 4+3 slow growth will give you many years with minimal issues..

Because of the .96 are you considering surgery so that you can do radiation if something does come back?

Sure would be interesting to hear with the PSMA pet shows. The decipher isn’t based on that, But that’s more information that’s really useful for decision-making.

Decipher score measures number of mutations in 22 RNA markers and if it is high it means that cells have very high potential to escape and form metastasis in the body.

So - even if you have 4+3 gleason that was seen on biopsy (and you have to keep in mind that biopsy examines only 1 % of the whole gland) and you have high Decipher - your cancer cells are very aggressive in nature.

It is possible to have opposite case also - gleason 8 and LOW Decipher. In that case person has very slow growing cancer regardless of gleason score and can have RT without ADT.

ADT is no fun, but perhaps short period of 6 mos might be beneficial since your Decipher is so high. I would consult several doctors before deciding what path to take if you decide to have RT.

@jeffmarc I appreciate your sharing.
PSMA PET not until 1st week December. I will let you know.
Last thing my urologist said to me, before he retired last year, was 'I am more worried about your kidneys than your cancer'. So, sure was surprised with Decipher!
Going to see if Mayo FL will take me for Tulsa Pro. I did have a HoLEP in 2023 (best thing that I ever did), and that might make a difference.
I am in excellent health otherwise

@service1010
When you are on ADT or even an ARPI drug they do blood tests for kidney and liver issues every time you have a blood test.

I after all these years, my tests For those two things have always been normal. I do have a tumor in one of my kidneys, but it’s not cancerous.

@service1010
This link may interest you. It gives a full description of what is found in a decipher test. Multiple pages showing the results for somebody with a fictional .88.
https://decipherbio.com/decipher-prostate/physicians/rp-test-report-overview/

Here is an excerpt from "Radiotherapy for Unfavorable Intermediate Prostate Cancer" published by the BackTable Urology podcast

Dr. Aditya Bagrodia, associate professor of urology, UC San Diego Health, and adjunct professor of urology at UT Southwestern, is the interviewer:

"You mentioned genomic classifiers. I mean, one that I'm quite familiar with is a Decipher Score. Are you pretty much routinely getting them in these patients?"

Dr. Neil Desai, radiation oncologist UT SouthWestern, replies:

"Yeah, of course I have a conflict of interest there, being involved in the study involving Decipher, though, not consulting for them. Of course. but, I certainly could Decipher anyone where there's an actual decision. If I'm fairly convinced they need hormonal therapy based upon the constellation of high risk features, with an unfair management risk, they will not benefit from adding Decipher - other than prognosis.... [But I would order it if] ...they are legitimately not sure whether they want the side effects of hormone therapy to justify the benefits. So I think it's something that I've slowly gotten to do more and more just because it does seem odd to go into a case, not knowing what the absolute risk is of metastasis and progression, as best as we can tell. And certainly genomic stratifiers like Decipher, especially Decipher in the radiation setting, add to that information for the patient."

The info from any test can only be described as best we can tell.

Medicare approves the payment for a decipher test. .

It is true however that if someone has multiple aggressive PC issues a decipher test doesn’t add to the diagnostic information. The chance of recurrence is known to be very high.