Finally persuaded my urologist to order ExoDx Prostate (EPI) test

Posted by benz57 @benz57, Sep 16 9:22am

It took 4 months, but my urologist is ordering me an at home ExoDx kit. He wanted me to just do a biopsy, but with a pirads 3 mri, I wanted to do the exodx first before an invasive biopsy. If it comes up negative, I will probably continue with a psa test every 3 months ( what I am currently doing). I think the ExoDx is a strong predictor in the case of a negative result. So, it would be reassuring that my current psa testing without biopsy is safe.

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oldmariner | @oldmariner | Sep 16 9:38am

I agree with the decision and wonder why the urologist is so eager to do a biopsy. Are there other 'warning lights'?

ezupcic | @ezupcic | Sep 16 10:09am

hi. what is your psa?

notpetecrowarmstrong | @notpetecrowarmstrong | Sep 16 10:23am

Cautionary tale: I had a very low ExoDX score that gave me <5% chance of clinically significant cancer and a single PI-RADS 3 lesion, but my oncologist still wasn't comfortable with my PSA of 6.5 at age 50. So I had the biopsy and we found a 3+4 tumor that tested genomically as highly aggressive (95th percentile). Had I put off biopsy and diagnosis for a year or more, I might have been facing confirmed extra-prostatic spread instead of localized cancer.

I'd strongly recommend you go for the Episwitch PSE test instead of an ExoDX test. The overall accuracy is much greater for the PSE test: https://www.researchgate.net/publication/389927751/figure/tbl1/AS:11431281317012090@1742308658057/Comprehensive-comparison-of-prostate-cancer-diagnostic-tests-focusing-on-their.png

Jeff Marchi has shared this helpful comparative chart in the past. Just keep in mind that it's published by the makers of the Episwitch PSE test and is intended to highlight its comparative benefit. But the data appears to be third-party-vetted.

benz57 | @benz57 | Sep 16 11:15am

In reply to @ezupcic "hi. what is your psa?" + (show)

@ezupcic 5.80 last one Sept 2nd. My usual is 5.20.
Both which can be attributed to a 94 cc prostate.

benz57 | @benz57 | Sep 16 11:20am

In reply to @oldmariner "I agree with the decision and wonder why the urologist is so eager to do a..." + (show)

@oldmariner No. The center I go to just goes from mri to biopsy. They dont use intermediate test like the exodx. Im pleased theyre allowing this, but they just dont offer anything extra.

benz57 | @benz57 | Sep 16 11:31am

In reply to @notpetecrowarmstrong "Cautionary tale: I had a very low ExoDX score that gave me <5% chance of clinically..." + (show)

@notpetecrowarmstrong it was a struggle to get the exodx, probably wont try for another. However, the exodx has a high negative prediction value, and is, in fact, made as a "rule out" test. All of this you probably know. I will keep your advice in mind though. If my psa drops back to baseline, or if it gets to something as high as 6.50, I would just go with the biopsy. Exodx is just another number in the mix. Thanks.

ezupcic | @ezupcic | Sep 16 12:29pm

In reply to @benz57 "@ezupcic 5.80 last one Sept 2nd. My usual is 5.20. Both which can be attributed to..." + (show)

@benz57 I’m in a similar situation but my psa has fluctuated from 4.5 to 8.8. my mri’s have been pirads 3 and 2. prostate has been 90 ml and 70 ml. prostate density still below 0.15. My doctor not very interested in PSE or MPS 2.0 but wants me to go to biopsy. traditional transrectal 12 core. I’m doing another MRI next week and then will decide next steps.

oldmariner | @oldmariner | Sep 16 3:17pm

Transrectal is so 'old school'.
I would insist on a transperineal biopsy; lower chance of infection. Not all urologists have learned the procedure.

ginger38314 | @ginger38314 | Sep 16 6:23pm

I had the exdos test because of my pirads 3 mri findings came in high at 77 so a very high chance of 3+4 or greater and 3+4 for now is what I ended up with currently awaiting treatment pending pet scan due to high decipher score.