When is a decipher score indicated?

It should be done on your biopsy samples as soon as they find 3+3 or 3+4 gleason score. Decipher will tell you how aggressive your cancer is and according to that what treatment and if any is needed.

A lot of folks commented in a thread, in this forum, a couple years ago about the Decipher Patient and Decipher GRID reports, which you may find helpful, here:
https://connect.mayoclinic.org/discussion/using-decipher-grid-report-to-help-guide-your-treatment-decision/

@tjv1156
I asked Oxford Biodynamics to order mine as part of my Biopsy process. Doctors do use it and do change their treatment decisions because of its data.

Decipher is not the only biomarker (genomic) test available to provide pre-treatment information. There are many different biomarker tests, depending on what you’re looking for:

> FoundationOne®Liquid CDx; Guardant360; Caris Assure.
> Prolaris; OncotypeDx.

Liquid biomarker tests:
> (blood): 4KScore; EpiSwitch PSE; Phi Prostate Health Index;

> (urine): SelectMDx; PCa3 (PC Antigen 3); MyProstateScore (MPS), ExoDxre.

(I’ve probably missed others.)

So, it depends on what biomarker information you’re looking for. (I had the OncotypeDx and Prolaris tests; never had a Decipher test.)
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I asked my urologist for Decipher test on biopsy & final pathology Gleadon3/4-7 for prostatectomy. He said I didn’t need it. I was more concerned because I had 2 (0.5mm positive margins of 3 cells at margins. I assume they can still do decipher in future.

I had a prostatectomy in 2022, the pathology showed Gleason 7 (3,4) where the 4 was 30% and had cribform. Two locations the cancer went to the margin. I had EPE. They did not do a decipher test. Pt3a. No Seminal or lymph node cancer.
You should get the decipher test so you get another picture how aggressive it is.
Two years I had PSA <.02 then it started to rise. When it reached .15 they did a decipher test on my prostate. The decipher test was .92, being very aggressive and made them want to do radiation and ADT for six months. I am 5 months into ADT with Orgovyx and have completed 24 of 38 radiation treatments.
From my original pathology with the questionable margins, cribform and EPE I knew I had a good chance of reoccurence. Being Gleason 7 I did not think it was highly aggressive, it is rare for a Gleason 3,4 having a .92 decipher. It is better for you to know up front what the decipher is especially if you have a margin issue. It will give you a better picture of what you will have to do on a reoccurrence.