New prostate cancer diagnosis: Wonder if focal therapy is right for me

Arterra uses AI to compare the appearance of a biopsy slide with that of thousands of others. Decipher uses the genome to identify cancer causing genes (22 of the most common). The criticism of the genetic tests such as Decipher is the prognostic aspect. Developed before PETCT Scans they
may be too pessimistic as I recall.

@jeffmarc appreciate your response as it is very helpful

This is all so new to me

@thmssllvn
Have you found some documentation that shows there’s a problem with the decipher test? I would really appreciate the opportunity to read that.

@jeffmarc I am ‘remembering’ what Dr. Scholz had said. He merely thought the prognostic part
was weaker, relying on pre psma scanning data if I recall correctly?

Dr Scholz was saying in one video, which I don't think I marked down, that Decipher often makes huge scores in comparison to others he uses, like way off from two or three others he uses in their practice. So he tends to ignore Decipher in many cases, but he may use it in some circumstances, it wasn't clear from what I saw. I have seen that in one video. Many other people saying differing biopsy sample sent returned way differing scores on Decipher probably from differing providers they tried during there working on finding a right provider for them, so I have seen that too - same lesion way differing score. Other mention it scored higher comparison to other tests, so not noted by their docs but differing providers they worked with used differing tests, giving exactly what Dr Scholz says the same basically - which is Decipher scores way higher than other tests.

I don't think Monte Carlo medicine is for me. Keep in mind some circumstances probability models and data models can work, but they also break down badly. In quantum electronics they model electron orbitals with these monte carlo methods to try and find if they should build a semiconductor with arsenic + silcone or some other things. They use these methods in labs before experimenting, so for experimental purposes and modelling. I don't like being an experiment too much. But if it works for you, then it is for you I guess.

I’ll look for the video and watch. Will discuss with Dr in 6 weeks. Appreciate your sharing this with me

@bjroc
I know one guy that had the Prolaris, Decipher and Artera AI tests, And they all came in about the same. People in here who have had multiple tests have Usually have them come in very similar. I can imagine there are people that don’t have this happen. I seem to remember one time a significant difference occurred.

@jeffmarc very good information

Dr Scholz, who isn't a lover of the over-treatment protocols out there in the prostate world, calls Decipher the most "pessimistic" of all the tests, meaning it pushes doctors to over grade, and over-treat. So if you believe lots in Decipher means one is probably in agreement with over grading and over-treatment, plus all the over treatment protocols and vocal pushes that go with it. It is up to you as a patient, if you feel over-treatments are in your best interest go with that. I like Dr Scholz he helps move away from all that. Fortunately not all doctors are into over treatment and that feel of a push agenda for that, though some become part of that and make extra money that way.

The discovery of my prostate cancer began when my PSA had risen from the mid twos to over four. My urologist recommended an MRI of my prostate, which resulted in finding two prostate tumors. The tumors were both contained within the prostate. Next was a biopsy. I chose an ultrasound-guided transperineal biopsy because that type of biopsy uses the MRI information as a road map to make sure the suspected areas are tested. My biopsy showed prostate cancer in the tumors.

Based on my Gleason score of 3+4=7 and a Decipher test showing low risk, I was a candidate for active surveillance. However, one of the tumors abutted the edge of the prostate, so I chose to have the tumors treated. I didn’t want to risk the tumor spreading outside the prostate. I was not excited with the possible side effects of removing the prostate or treating it with radiation, so I did research on focal treatments.

Focal treatments focus on treating prostate cancer by attempting to kill the tumor(s) without removal or radiation. These treatments are not for everyone and seem to require that the cancer has not spread beyond the prostate. There are several types of focal treatment such as High-Intensity Focused Ultrasound (HIFU), Transurethral Ultrasound Ablation (TULSA Pro), cryotherapy, Irreversible Electroporation (IRE), and others. I chose the IRE Nanoknife treatment which uses electrical current in an attempt to kill the tumor. This treatment was done at Moffitt Cancer Center in Tampa by Dr. Julio Pow-Sang.

The IRE Nanoknife procedure went well for me. It took about an hour in total, I'm sure a good part of that was the preparation after I was put under. I think the actual procedure took about 30 minutes.

After the procedure, I had some spasms that were quickly relieved by medication. I had a catheter, which I was a bit concerned about. As it turned out, I had it for six days and didn't have any problems with it. I even removed it myself, which was surprisingly painless. I removed it in the shower so any urine that might have leaked out could be taken care of easily.

After removing the catheter, I had leakage and used pads in my underwear for about six weeks. For the first several weeks, there was blood in the urine, but that eventually cleared up. I still had occasional spotty leakage for a while, like when I sneezed or coughed, but that cleared up. This really hasn't been a problem. Sexual function is the same as before surgery.

Three months after the procedure my PSA came down from 4.25 to 2.5. Six months after the procedure the PSA was down to 1.53. A multiparametric MRI (mpMRI) was also done at six months and it showed “post ablation changes of the prostate with no new or recurrent tumor in the treatment area and no new suspicious lesions in the prostate." My doctor was very pleased with these results and deferred another prostate biopsy for the time being. At 18 months post-surgery, another MRI was done and the result was good. Subsequent PSA results are good with values of around 2.

I'm very pleased with the results so far. Best wishes to all seeking a treatment plan best for them. I would highly recommend that everyone consult with a Cancer Center of Excellence. That type of facility is equipped with the specialists, staff and technology which is particularly effective in treating cancer. In addition to Moffitt Cancer Center, which I highly recommend, I have been a patient of Mayo Clinic for many years and have always received the best of care. Both organizations are Cancer Centers of Excellence.