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Validity/weight of Artera and Decipher Tests

Posted by fiskadoro @fiskadoro, 4 days ago

57 year old male, exactly one year removed from a prostatectomy. Gleason 7, cancer was confined to prostate, seminal vesicles and 2 lymph nodes. I recently had a rise in my PSA to .34, and I went in to see a radiation specialist on my care team. He immediately mentioned ADT therapy in addition to radiation, and I told him I was interested in seeing the results of my Decipher and Artera scores before I chose any course of treatment. When I asked would a delay of a few weeks be in any way detrimental, he said "no".

Then yesterday I went to see the hematology oncologist, who downplayed the importance of a Decipher or Artera test, instead mentioning that he wanted me to do between 6 months and 2 years of ADT in addition to Apalutamide. I was a bit surprised that he just seemed to quickly discount both the Artera and Decipher exams, and when I asked why, he mentioned a study that I (obviously) wasn't familiar with.

I am feeling rushed, and I want to defer to their expertise, but I feel a bit uncomfortable with how he seemed to give little credit to the two exams I mentioned, though he did tell me that he wanted me to take a genetic test. I of course want to avoid hormone therapy and am going to consult with a Cyberknife specialist, as well as the Mayo Clinic in Rochester. I am curious to see what others think, because the radiation specialist was impressed with the research I'd done, and to have both tests - as consequential as they can potentially be - dismissed so casually does not sit well with me. Am I missing something?

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fiskadoro | @fiskadoro | 4 days ago
In reply to @surftohealth88 "Decipher measures number of mutations in RNA segments - some mutations have nothing to do with..." + (show)
Profile picture for surftohealth88 @surftohealth88

Decipher measures number of mutations in RNA segments - some mutations have nothing to do with PC so there is no need to check for ALL of the mutations.

Decipher measures number of mutations in the sample, "load" if you will. The more "scrambled" RNA is the higher the score.

Decipher will tell how aggressive the cancer is (or the potential of it becoming aggressive in the future) so if somebody is intermediate but has high Decipher it will change the course of the treatment. For example if somebody is 4+3 and low D., that person can avoid ADT, and if somebody is 4+3 and D. is 85, than ADT would be advisable. Same way Gleason 8 with low Decipher can avoid ADT , etc.

@fiskadoro for example has cancer that escaped his gland - it is in lymph nodes and vesicles ! Decipher would definitely help with treatment plan but as far as I know there would be very little chance that he can escape ADT since cancer is spreading : (((. I do not know why they did not suggest very early salvage ( before 0.1 ) with such case where cancer already escaped gland ?

Salvage RT has the best results when it is done before PSA reaches 0.2 , after that success is lower and lower. After 0.5 it is less effective.
https://link.springer.com/article/10.1007/s00345-025-05840-w

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@surftohealth88 I was PSA tested about 2.5 months after surgery, but not again for 8 months. I now know that I should be testing every three months, but in hindsight I wish my care team had scheduled me for more frequent testing.

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fiskadoro | @fiskadoro | 4 days ago
In reply to @gently "Decipher tests the genetics of the tumor. It can tailor your care. It averages whether your..." + (show)
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Decipher tests the genetics of the tumor. It can tailor your care. It averages whether your tumor is likely to be metastatic, more aggressive. It's a clue as to whether you might watch and wait or whether you should have radiation or surgery, or you really should use ADT or not.
Patients should have hereditary genetic testing. Together these test are most important for any chemotherapeutic applications.

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@gently I am scheduled for genetic testing this coming Friday.

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surftohealth88 | @surftohealth88 | 4 days ago
In reply to @fiskadoro "@surftohealth88 I was PSA tested about 2.5 months after surgery, but not again for 8 months...." + (show)
Profile picture for fiskadoro @fiskadoro

@surftohealth88 I was PSA tested about 2.5 months after surgery, but not again for 8 months. I now know that I should be testing every three months, but in hindsight I wish my care team had scheduled me for more frequent testing.

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@fiskadoro
I am so sorry dear Fiskadoro to hear that : (((. With your pathology they should have ordered tests every 3 months (at least). You still caught it in time, though, just do not wait too long with treatment.

I had to learn and read tons of studies in the past year so that I would be able to help my husband. He has gleason 9 and very aggressive cancer and because of that we checked his uPSA every single month (we ordered tests ourselves in local lab) and that proved to be a life saver - we caught his BCR very early. If we followed his doctor's schedule, he could have missed this early window for treatment himself also.

Since your cancer left your gland already, please try not wait too long before treatment starts. Did they order PSMA and MRI scan for you ?

Wishing you the best of luck and super successful salvage radiation. 🍀

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heavyphil | @heavyphil | 4 days ago

You are one year out from surgery and your PSA has already climbed to 0.34. Your cancer was ‘confined’ to the gland, seminal vesicles and 2 lymph nodes? That’s not the type of cancer I would call confined.
It’s already visibly spread to 2 lymph nodes so there’s a very good chance it has moved further out in the chain.
Microscopic examination of unaffected glands can miss a few PCa cells- and that’s all you need for further spread.
Although I understand your desire to know more about your cancer via genetic tests, look at the obvious first:
Cancer already spreading at the time of surgery; BCR very soon after surgery. That indicates a more aggressive cancer no matter WHAT a genetic test says.
I was G4+3 unfavorable with cancer confined to the gland and negative margins. I developed BCR 5 yrs later and after one RO told me I didn’t need ADT, I RAN to one who said I did.
Did 6 months Orgovyx - no biggie!! - and 25 radiation treatments. DON’T be afraid of Orgovyx ( stay away from Lupron!) since it may save your life. Genetic tests are not foolproof and you don’t want to regret putting all your faith in today’s cutting edge technology, when tomorrow it may be found to be less than perfect. Just my opinion based on personal experience and my desire to hit back with every tool at my disposal, every single time…Best,
Phil

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bens1 | @bens1 | 4 days ago

nccn.org, an organization that a large number of doctors follow as guidelines for treatment, views Decipher as a validated, clinically meaningful tool that improves risk stratification and guides treatment decisions. It is recommended, evidence‑supported, and integrated into multiple decision points.

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fiskadoro | @fiskadoro | 3 days ago
In reply to @brianjarvis "I don’t think it’s about “giving little credit to the two exams.” It’s about not getting..." + (show)
Profile picture for brianjarvis @brianjarvis

I don’t think it’s about “giving little credit to the two exams.” It’s about not getting a test simply for the sake of getting a test.

You have to consider how the test results may change treatment management. There are many different biomarker tests depending on what you’re looking for:

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

Liquid biomarker tests:
> (blood): 4KScore; EpiSwitch PSE; Phi Prostate Health Index;
> (urine): SelectMDx; PCa3 (PC Antigen 3); MyProstateScore (MPS), ExoDx.

(I’ve probably missed others.)

So, it depends on what biomarker information you’re looking for and what you plan to do with it. (I had the OncotypeDx and Prolaris tests; never had a Decipher test.)

On the other hand, you shouldn’t feel rushed. You should expect to get all your questions answered - sometimes the answer may be “no”, if they can explain why (or why not). But, even if they say “No” to ArteraAI (as just one example), if you still want the test, they should arrange it for you (if insurance will pay for it).

(I had 28 sessions of proton radiation with 6 months of ADT. Treatments were relatively uneventful.)

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@brianjarvis That is encouraging that the treatments were relatively uneventful, glad to hear you did not have to suffer. I have read so much about bone loss, depression, shrunken testes, etc. I have heard that these things are not recoverable, or at least a good percentage of the loss is irrecoverable.

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K. J. HOLZ | @kjholz | 3 days ago
In reply to @jeffmarc "Some doctors really do like the tests because they can differentiate between those that need ADT..." + (show)
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Some doctors really do like the tests because they can differentiate between those that need ADT and those that don’t. Other doctors are just not up on what’s going on as much. The same thing is a problem with medical oncologist. If they have not been trained as Genito urinary oncologists Then they don’t specialize in prostate cancer and don’t keep up with everything going on. They do work with all different types of cancers so they can’t specialize.

I know one guy who has only a Gleason 3+4, but he has large cribriform. His decipher and Artera tests are both very low. He is now in his second year, waiting for treatment because he doesn’t feel he needs it yet. He has seen multiple specialists and they all agree with him, even Dr. Epstein Who specializes in second opinions of biopsies.

Good to hear you are seeing other doctors and can probably get the tests from one of them.

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@jeffmarc Hi Jeff. Is it true that you can have a low Decipher result and then a few years later after another biopsy, score higher --or even go from Low to High?

Thank you and Cheers.

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brianjarvis | @brianjarvis | 3 days ago
In reply to @fiskadoro "@brianjarvis That is encouraging that the treatments were relatively uneventful, glad to hear you did not..." + (show)
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@brianjarvis That is encouraging that the treatments were relatively uneventful, glad to hear you did not have to suffer. I have read so much about bone loss, depression, shrunken testes, etc. I have heard that these things are not recoverable, or at least a good percentage of the loss is irrecoverable.

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@fiskadoro Most of those things can be tracked/monitored:
> getting a baseline DEXA scan and then periodic tracking for bone density loss.
> as for depression - Exercise turns on many types of switches in the parts of the brain that puts us in a better mood. It reduces stress, anxiety, depression, catastrophizing, and more. Incorporating resistance-training exercise is a necessary part of the routine to minimize the potential physical/mental side-effects of hormone therapy.

Also, Many cancer treatment centers have counselors to help patients and family members in dealing with the emotional and mental aspects of the treatments we’ve chosen to treat our prostate cancers.

Most side-effects of hormone therapy can be minimized with resistance-training exercise to offset the metabolic affects.

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Jeff Marchi | @jeffmarc | 3 days ago
In reply to @kjholz "@jeffmarc Hi Jeff. Is it true that you can have a low Decipher result and then..." + (show)
Profile picture for K. J. HOLZ @kjholz

@jeffmarc Hi Jeff. Is it true that you can have a low Decipher result and then a few years later after another biopsy, score higher --or even go from Low to High?

Thank you and Cheers.

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@kjholz
We have heard from people in this fourm that have had exactly that happened to them. Decipher test at different times with different tissue have come up with different results. Both higher and lower.

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K. J. HOLZ | @kjholz | 3 days ago
In reply to @jeffmarc "@kjholz We have heard from people in this fourm that have had exactly that happened to..." + (show)
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@kjholz
We have heard from people in this fourm that have had exactly that happened to them. Decipher test at different times with different tissue have come up with different results. Both higher and lower.

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@jeffmarc Thank you for answering and good to know I remembered correctly. We were going to order one (had it in the works) when I read something like that and decided to regard ourselves as High Risk and be done with it. Knowing a Low can morphed into High on a subsequent Decipher wouldn't reassure us anyway.

Cheers and thanks for what you contribute on this forum! 💖👍

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