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Decipher risk: prostatectomy RP vs radiation.
Prostate Cancer | Last Active: Mar 14 11:09am | Replies (75)Comment receiving replies
Thanks-I'm now realizing that Decipher really is a tool for radiology to access whether they need to add hormone therapy or not. In my case, if I did radiaiton, yes I would.
For surgery, with no spread on the imaging, it looks like options are potentially still open for nerve sparing surgery. If there was spread, I guess radiaiton would be the way the go.
I'm also seeing that surgical internal sphincter/ bladder neck area rebuild areas are big determinants of continence down the road. Guessing that's a surgical decision as they get in there.
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@fritzo Even our current best prostate cancer scanning technology, the PSMA PET scan, is still very weak in that the smallest cancer cell cluster it can see is 2mm which requires 8 million cancer cells to create. Given this situation, it is very easy for some cancer escape to have already occurred and not be seen. Without definitive proof of escape, we are left with evaluating a lot of indirect clues towards the possibility that escape has already occurred.
The more you have of these high risk factors, the more likely that escape has already occurred. High Decipher score, intraductal, cribriform, seminal vesicle invasion, perineural invasion, extraprostatic extension (EPE), extracapsular extension (ECE), and even just lesions that abut the capsule wall. In my own case, I had a high Decipher score (0.81) and two lesions that abutted the capsule wall. The high Decipher score and the two capsule abutting lesions suggested that I needed more ADT than normal with radiation and that's why I had to use one year of ADT with just a contained 3+4 case.