Are castration sensitive prostate cancer patients being over treated?

@gkgdawg I was disagreeing with your oncologist’s statement that a genetics test does not apply to him because his father developed PCa in his 60’s. Genetics is the basis (IMO) for prostate cancer so knowledge is power, treatment-wise.
However, if your husband has a relatively lower Gleason score, Decipher test, negative PSMA, etc., your doctor may simply mean that it is not necessary since treatment will unfold along fairly standard lines; in other words, nothing dire or of
Significance.
Phil

@gkgdawg I was disagreeing with your oncologist’s statement that a genetics test does not apply to him because his father developed PCa in his 60’s. Genetics is the basis (IMO) for prostate cancer so knowledge is power, treatment-wise.
However, if your husband has a relatively lower Gleason score, Decipher test, negative PSMA, etc., your doctor may simply mean that it is not necessary since treatment will unfold along fairly standard lines; in other words, nothing dire or of
Significance.
Phil

@gkgdawg
Technically speaking what the issue would be is that genes are selected and omitted. So the likelihood of bad genes is higher (if never actually checked in your father) that he had a bad gene (or two ...), and the possibility is there that if he had a bad gene it (they) was passed onto you, but the only way to be certain is to test you.

Now the doctor may have treatment guidelines on all this so it's not entirely his decision and the genetics test costs whatever it costs but isn't too cheap, and that's what that is. So no matter how high the odds, the only way to be certain is to run the test. You're not a number you're an individual. And more and more medicine is guided for solid scientific reasons on genetics.

At worst it confirms what he's already assuming.

But at best it's a new guideline that might save you from over-treatment - and even save the insurance company some money!

@carbcounter Thank you so much. Our health insurance is public. But that could still mean that the physicians want to save the government money or are restricted in if and when they can do the testing, I suppose

@heavyphil
If a genetic test shows that he has BRCA2 some of the doctors are starting to treat it early with a PARP inhibitor. It would be very useful to know if there are genetic issues if you are younger and getting prostate cancer.

We have another guy that’s been posting here who has ATM And got prostate cancer at 46. Turns out, Lupron didn’t work for him to reduce testosterone, but Orgovyx and Firmagon did. Would be useful to know those kinds of things.

@heavyphil Hi, my husband's Gleason score was 7. He had a PSMA and that determined that the cancer had metastasized. I don't know what a Decipher test is

@northoftheborder
This is true. The more aggressive the original prostate cancer case the less likely waiting for it to get worse makes sense. If you have an aggressive case, you probably need aggressive treatment.

That’s one reason castrate resistant cases were not included in this discussion.

@jeffmarc This makes me question whether you should be waiting on even more aggressive cancer. The question becomes at what level of aggressiveness do you treat. They use to treat Gleason 6 and now they do not. Now treating Gleason for bcr until higher levels are reached. Dr Kwon says you should wait until things show up since it is most likely spread. The problem is people who are more aggressive are treated and you have very little comparison. The question of what is aggressive is still being figured out. Now it is psma of doubling or is it decipher or Gleason or cribform or genetics or some combination? Are some people more prone for spread? This article makes me realize I am making decision on statistics which had a different basis for bcr. When I look at the statistics showing treating before .2 is better for aggressive the question comes up is this because the group has more people in it that will take many years to getting metastatic from the low levels they are at or some may not progress at all. It makes me question even if it is aggressive should you wait or what really makes it aggressive especially because you should not use doubling at .2. There is so much more to understand.

@gkgdawg A Decipher test is itself a form of genetic testing which tests for aggressiveness.
Your husbands Gleason score of 4+3 (same as mine) is classified as Intermediate.
HOWEVER, all G4+3’s are not the same - some are more aggressive than others. The fact that his has spread to the nodes indicates a higher level of aggressiveness.