Decipher score

@ginger38314 wrote " I am very concerned about post-surgery outcomes, especially since a high Decipher score doubles the risk of adverse pathology to roughly 40%"

Do you have a source for that statement?

Also, "adverse pathology" can mean different things in different contexts. In the post-RALP pathology, it can refer to a range of histological features (e.g., cribriform, IDC-P, LVI) or to different types of observed local spread (e.g., SVI, EPE, lymph nodes).

Radiotherapy does not necessarily address all of these better than surgery, so I'd suggest caution in how you're interpreting what you're reading, and discussion with a medical oncologist when you have questions.

@ginger38314 wrote " I am very concerned about post-surgery outcomes, especially since a high Decipher score doubles the risk of adverse pathology to roughly 40%"

Do you have a source for that statement?

Also, "adverse pathology" can mean different things in different contexts. In the post-RALP pathology, it can refer to a range of histological features (e.g., cribriform, IDC-P, LVI) or to different types of observed local spread (e.g., SVI, EPE, lymph nodes).

Radiotherapy does not necessarily address all of these better than surgery, so I'd suggest caution in how you're interpreting what you're reading, and discussion with a medical oncologist when you have questions.

@ginger38314 wrote " I am very concerned about post-surgery outcomes, especially since a high Decipher score doubles the risk of adverse pathology to roughly 40%"

Do you have a source for that statement?

Also, "adverse pathology" can mean different things in different contexts. In the post-RALP pathology, it can refer to a range of histological features (e.g., cribriform, IDC-P, LVI) or to different types of observed local spread (e.g., SVI, EPE, lymph nodes).

Radiotherapy does not necessarily address all of these better than surgery, so I'd suggest caution in how you're interpreting what you're reading, and discussion with a medical oncologist when you have questions.

@ginger38314
My MRI in early March 2025 identified two PI-RADS 4 lesions and one PI-RADS 5 lesion. A PET scan at the end of March 2025 identified two foci of Pylarify uptake within the prostate, consistent with the MRI findings, but nothing elsewhere.

A biopsy in May 2025 found Gleason 3+4 cancer in only 1 of 18 cores. A GPS test in June 2025 came back at 47, indicating a high genomic risk.

I underwent surgery in early September 2025. The final pathology showed pT3b disease with seminal vesicle invasion (SVI), lymphovascular invasion (LVI), and perineural invasion (PNI). My Decipher score subsequently came back at 0.75.

So, my prostatectomy took place within about six months of the concerning MRI findings. Given the aggressive biology of your cancer, I can certainly understand your view that, in your situation, moving toward treatment sooner rather than later may be the better approach.

@notpetecrowarmstrong

I might be wrong, but I think that he is worried that PSMA and MRI will show no spread and that PC is contained within a gland but that post surgery pathology might discover that cancer is NOT contained and that it already speared in vesicles or nodes which in that case would make RP redundant as the first step.

Although I do not think that glands are routinely irradiated during primary PC RT ?

@notpetecrowarmstrong

I might be wrong, but I think that he is worried that PSMA and MRI will show no spread and that PC is contained within a gland but that post surgery pathology might discover that cancer is NOT contained and that it already speared in vesicles or nodes which in that case would make RP redundant as the first step.

Although I do not think that glands are routinely irradiated during primary PC RT ?

You are exactly right. That's my concern.

Is GPS test different from decipher test.

@ginger38314

The question you need to ask your radiologist, then, is what their plan is in terms of irradiating tissue outside the prostate gland. For example, do they recommend widening the target field to address potential spread just outside the gland? Do they plan to target any of the pelvic lymph nodes?

If you're not going to be irradiating outside the prostate, then you're not necessarily going to be addressing unseen spread. And if you are going to expand the radiation field, then that changes the side effect profile.

High-genomic risk cancers also sometimes exhibit what's known as radioresistence. That could increase the risk that the whole-gland radiation is less effective at eradicating the disease within the prostate than surgery would be.

You should discuss all this in depth with your care team when weighing the benefits of surgery vs. RT.

@ginger38314

The question you need to ask your radiologist, then, is what their plan is in terms of irradiating tissue outside the prostate gland. For example, do they recommend widening the target field to address potential spread just outside the gland? Do they plan to target any of the pelvic lymph nodes?

If you're not going to be irradiating outside the prostate, then you're not necessarily going to be addressing unseen spread. And if you are going to expand the radiation field, then that changes the side effect profile.

High-genomic risk cancers also sometimes exhibit what's known as radioresistence. That could increase the risk that the whole-gland radiation is less effective at eradicating the disease within the prostate than surgery would be.

You should discuss all this in depth with your care team when weighing the benefits of surgery vs. RT.