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Decipher Results are in... ADT recommendations?
Decipher test results just in and unfortunately I'm in the high-risk range for metastasis at .69. Awaiting discussion with RO. Anxious to find out if there are any PC brothers out there who are further down a similar path. I'm 70, good health, PSA never above 3.4, single 1 cm lesion right side, 4+3 (intermediate, unfavorable), left side clean, all tests point to localized disease. Prepping to start 5 session SBRTs at Mayo Jax next month. RO told me earlier he'd use Decipher tests results to guide potential multi-modal therapy recommendations but already said if high risk, would likely recommend RT be followed by Orgovyx for 4-6 months. Anyone else in a similar situation further down this path?
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WHY Orgovyx? I demanded a safer (CV) option than the agonist Eligard and was given Orgovyx as THE antagonist option. It was not covered by insurance and at $2800/mo, Leydig cells (in the testis) become very expensive so I did the unthinkable and asked for Leydig cells removal. Then I was told about Firmagon that is not only cheaper. It is covered by insurance and I went with Firmagon with no regrets. Finally I asked given I have mCSPC is there any protocol where Leydig cells are allowed to come back? If your PC is not metastatic, both antagonist allow longer ADT treatment before it must be stoped to save not only Leydig cells but improve bone health, etc. I still have not received an answer to my question.
I had a DECIPHER done on 9-12-2018. My risk was even higher than yours: 1.0. 5-year risk of metastasis was 52.6%. Still survival at 10-year was 70%. Remember there are still numbers. I got ADT and Radiation Therapy. I have a very aggressive cancer. I would suggest that you go for radiation for sure. Get ready for side-effects. ALL cancer treatment cause them. I still wear a pad 5 years removed from surgery and radiation. But I feel good. And I can see my kids and wife, friends and family. Wish you the best.
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1 ReactionI received ADT ( lupron) with Erleada ( androgen inhibitor ) for 13 months with RP in the 6 th month and I was advised that the combination of these 2 types of drugs gives a better result than just the ADT drug alone. I would recommend that you chat with you medical advisors about this strategy. My PC occurred when I was 74, Gleason 9, aggressive, CR stage 3C. Good luck to you and all of the guys here.
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2 Reactions69 years old with two of twelve cores at 30% Gleason 3+4. Decipher was very high. PSMA PET scan indicated the cancer is confined to the prostate. Opted for IMRT which starts tomorrow. Initially my urologist said he would be giving me ADT injections, but my RO was adamant that I did not need ADT. His thinking was that the small survival difference ADT would make was not worth the associated negative quality of life. He also pointed out the dangerous health issues that can be associated with testosterone blocking (cardiovascular in particular). His position is that my cancer is “low grade” and can be cured by radiation alone. The urologist and RO put their minds together and now the urologist agrees that ADT is unnecessary. I’m happy not to be taking ADT and hoping the docs are right. Time will tell.
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6 ReactionsHad it not been for the Decipher results, I probably would have passed on the ADT in spite of my single 4+3. From my research, I believe that tests such as my Decipher test will be a major factor in future ADT recommendations. There's a large ongoing NIH study looking at that particular subject now. Best wishes!
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2 ReactionsIf it was not for the Decipher test, I’d be doing active surveillance. Thankfully I now know that my PC needs to be treated. Though it seems most ROs recommend multi-modal therapy for those of us with high scores, my RO feels my “low grade” PC can do without ADT. 🤞
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3 ReactionsRead the article "Radiotherapy with or without androgen deprivation therapy in intermediate risk prostate cancer." It says there is no difference in results in men 70 or older if they take the jab of Lupron. There are other studies out there if you Google them.
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4 ReactionsThanks, I've read these studies. The meta-analysis study that I think you're referring did not delineate FIR versus UIR ("...The original intention of our meta-analysis study was to further divide intermediate-risk PC into FIR and UIR. However, after analyzing the included studies, we found that few studies conducted this subgroup analysis.). For the UIF group like me, especially with the confirmation of a Decipher analysis, I believe there's a stronger case for consideration for at least a short course of ADT. There is at least retrospective data which suggest that ADT benefits patients with unfavorable, but not favorable, intermediate-risk cancer, others suggest there is no added value with ADT for men over 70 in conjunction with RT. Bottom line, it's pretty squishy for a 70 yr old with UIR. I may roll the dice and do a short course (4 months) of ADT...
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1 ReactionNot sure what you decided but for what it’s worth I’ve spoken to a number of men who’ve done the short course and seem to come out of well. Just do your penile rehab and exercise during adt. All the best.
Get on Zolodex and stay on Testosterone is the fertilizer of PC