@notpetecrowarmstrong

Thanks for your informative comment!

Tumor heterogeneity makes sense in that even a biopsy with multiple positive cores usually has differing Gleason scores, as in my case.

The gene expression chart is from one of my tumors taken from a Gleason 3+4 core (of which I had two), while another 5 Gleason 3+3 cores were not tested.

As I said, all this data represents additional puzzle pieces of information….maybe I was overly optimistic regarding “more than half” of the puzzle pieces being missing.😉

It seems all characterization techniques suffer from ambiguity.

In my case, serial mpMRI’s indicated that my three originally observed lesions (PIRADS 3,4 & 5), two of which were initially identified (via targeted biopsy) as Gleason 3+3, turned out to be invisible in later mpMRI scans. My urologist indicated they were most likely “just inflammation” which resolved.

Probably the most frustrating aspect to the entire PCa prognostication process is when one finds out that the “puzzle picture” has morphed (to continue the analogy).

I’m aware of the limitations of Decipher testing and analysis, as I’m also aware of mpMRI’s and biopsy pathology interpretation ambiguities.

At the end of the day, we all make a risk based decision, based on as much clinical, biomarker, somatic genomic, germline genetic and any other data we can get our hands on.

That said I believe the Decipher information is important, when combined with all the other more routinely obtained information.

I think it, at least, pushes the decision towards more confidence regarding a particular treatment or active surveillance decision.

I also believe this information will only get more useful as the research continues.

Best!