Decipher for Subsequent Biopsies

Hello...so, correct me if I am wrong, but it is logical to assume that your urologist put you on Active Surveillance (AS) after your first biopsy, which tells me that perhaps your first biopsy yielded a Gleason Score of 3 + 3 = 6? Unless it was your personal decision to do AS after a biopsy yielded the 3 + 3 = 6 or more (3 + 4 = 7?, 4 + 3 = 7?), I would wonder why your physician did not recommend the radical prostatectomy (RP) if you were more than a Gleason "6"? You did not offer your first PSA value, but it must have been high enough to prompt the first biopsy and first Decipher Test Score (what were they?). You did not offer what your most recent PSA is either.

My personal advice, based on "my" experience, is if you are a Gleason 3 + 4 = 7 or higher, then have a serious talk with your urologist about having the RP. I am the not-so-rare, perfect example of what I speak about often here: My urologist was all happy that I was a low-moderate risk Gleason 3 + 4 = 7 ("we caught it early"). He thankfully still wanted to do the RP - and did - because he does not believe in AS. He was humbled and I was crestfallen, when my surgical pathology report came back with LOTS of unexpected, more aggressive disease characteristics: Extraprostatic Extension (EPE) where the tumor broke through and out of the membranous capsule that surrounds the prostate; Surgical Margins which means that despite removing all of the prostate, the two seminal vesicles, and two vas deferens, there were cancer cells left in me that extended beyond the prostate; Cribriform glands tissue (thin layer of prostate tissue stained on a microscope slide gives the appearance of "Swiss cheese" with holes in the tissue - an ominous sign), and worst of all: spread into my left seminal vesicle without tumor or nodules noted...just cells. This was all on my Gleason Score that was "barely" that 3 + 4 = 7. I only had 6-10% of "4" level cells, so I was just over the hump from not being a 3 + 3 = 6, yet the Gleason could have easily disarmed my physician, especially with just 6-10% of the cells being "4"..

I have now called this the "tip of the iceberg" in all of my many posts. The Gleason Score is just the "tip of the iceberg" that tells you nothing except if you do, or do not, have cancer and rates the cancer based on the enumerated/scored number of "3", "4", or "5" cells you might have. The Gleason Score says nothing about the anatomical features of the prostate and tumor, its aggressiveness/spread, and location of the spread if it did in fact bust out of the prostate membrane to adjacent areas. And once that happens, it is "all bets off" - EPE is the breaking point. If the tumor spread outside of the prostate membrane (EPE), you have no idea how far and for how long. They only know in part, because it is routine to remove the seminal vesicles and vas deferens because they are no longer needed. But it doesn't say if the cancer spread to your bladder neck, lymph nodes, etc. So, I would have a long and detailed talk about your first vs the second Decipher Test score, but more important than that is whether your Gleason Score advanced to a higher Score, even if it went from a 3 + 4 = 7 to a 4 = 3 = 7, that is not good. Good luck and keep us all posted.

@tdgillett
What was your original PSA? What was your original Gleason score. What risk level did your original Decipher come back as? Why are your doctors doing a second biopsy?

Are you on A.S.? If you are on A.S. I can see why you are having another biopsy.

I did not have A.S. But I also did 3 different opinions before deciding on my treatment plan. None of the recommended A.S. Thus I only had one Decipher prior to my treatment radiation plan. That Decipher test changed my treatment plan from radiation and hormone to radiation only. So you can see I am very pro Decipher testing.

Decipher is very patient friendly. If your insurance will not cover they will discount the costs and can set up a payment plan for you. A great company and a great diagnostic test to help with you and your doctors decisions on treatments.