Decipher score

Definitely take a look at SBRT radiation instead of surgery. With only two 3+4 cores that could easily take care of it completely, With less impact on your body and your time.

Did your PSMA PET scan show no spread (especially with that suspicious EPE)? Any concern about clear margins? Would be a shame to have surgery, then to have to come right back with radiation + ADT.

Try to collect enough information to be somewhat sure.

I emailed the oncologist and asked him about that.

Didn't have a pet scan because initially it was 3+4 low volume, just found
out today about the .86, the mri and biopsy didn't show anything it was oy
a .8cm lesion but I did bring that question up to my urologist this morning
about getting one.

@ginger38314 That’s good that you brought it up to the urologist. That would seem to be a “must have” given all that you’re dealing with.

He emailed me back and ordered one just can't believe something that's so
low volume ans 3+4 ends up being aggressive.

@ginger38314
So sorry to hear that : (((. It happened to my husband too. He had a single core 4+3 of more than 14 taken, and only 2 more with 3+3 . Decipher 1. (yes, the highest on the scale). Biopsy and MRI showed cancer "contained". PSMA showed no spread but one node was faintly glowing and far below what was considered "positive". Second expert confirmed that it was NOT positive but in reality it was. Post RP biopsy showed that that core was actually 4+5. At that time (just last year) all experts advised RP for high risk patients and than a new study came out recently which showed some advantage with having RT.

It is going to be tough choice and I am wishing you all the best and complete eradication of cancer with whatever treatment you choose 🍀.

@ginger38314 Whenever there’s a “4” cell type in the Gleason score, there’s always risk of metastasis. It’s good that they’ve ordered you one.

Take this opportunity to learn about PSMA PET scans, and what the results will mean.

Everything thing seemed favorable with Gleason score and only a.8cm lesion
so very bummed out at this point ordered a pet scan and hopefully that's in
the clear, my oncologist said they could treat it with adt and 5 sbrt
treatments so not sure what is best.

@ginger38314

My situation was nearly identical to yours: exact same .86 Decipher score and a low-volume 3+4 cancer in two cores. I opted for surgery largely because of my age (51 at the time): two radiation oncologists at two COEs both said they strongly recommended surgery over radiation given my youth and general health. I'm 14 months out from surgery and PSA remains undetectable, and functional recovery has been good, so I'm happy with my decision.

Of note, my post-surgical pathology found both large cribriform architecture and focal intraductal. Both of these are markers of aggressive cancer, and neither had been seen on needle biopsy. But the tumor volume and grading was the same as on biopsy, my margins were negative, there was no detectable escape from the prostate gland, and 5 lymph nodes were clear. Still, the high Decipher score and the cribriform/IDC-P had me uneasy.

You write "Everything thing seemed favorable with Gleason score and only a.8cm lesion
so very bummed out at this point". I felt similarly, so let me share something one doctor said to help me contextualize it: he said that "you had a very small amount of a very nasty cancer, but all indications are it was contained and your surgery was successful."

Everything other than your Decipher *is* favorable, and you're looking at favorable odds for successful treatment. Your cancer may be genomically aggressive but you seem to have caught it early enough where it's quite likely curable. Be grateful and put your trust in your care team to guide you through the process.