Post RP results: PSA and Decipher score. Asking for comments

30 months ago I was diagnosed PC had RP and they then upped my diagnosis to Gleason 9 CR high risk, had ADT and Erleada for 12 months. My PSA has been .01 since surgery (30) months. Some side effects but pleased with PSA level. Be cool. This is serious but it might be treated as long term chronic illness.

I hope you are recovering well from the surgery in November. Did you have a biopsy before the surgery and did that Gleason score match the score from the post-surgery analysis? As part of the post-surgery analysis, were the margins clear? Within the surgery, did they take any lymph nodes for inspection and if so, what were the results? --- All of these are reasonable questions to ask and be aware of, as you just completed a major event as part of your treatment.

I did not have a Decipher score, but your question about biochemical recurrence is a reality that it does happen, and hopefully it doesn't happen for you ever, or at least for a really long time.

As the other post shared, some patients are put on ADT therapy after surgery, however that might have been done because of their high Gleason score or because of margins that were not clear. So, it is best to get a sense of your results to share with the community here and folks will be able to provide more perspective.

Either way, continue to recover and heal from surgery, that is priority #1.

onward!

Thanks for responding. My pre-RP Gleason score was 3+4=7, after RP pathology came back 4+5=9. They determined my cancer was right at the capsule, but didn’t believe it had gone through. Lymph nodes were clear. My surgeon said he got it all but the PSA would be important in determining the next step. BTW, I had zero side effects after surgery. No incontinence at all ( I’m also a very healthy 71. Just had my yearly physical on Wednesday. Everything Aok.) I meet with my surgeon on April 1st as a Followup from my RP. This was set up prior to my decipher results. I’m a little anxious right now, but I’m assuming he doesn’t feel a need to meet earlier. 🙏🤞

Great news on the recovery, excellent!

April 1st can seem like a very long time away, but it is very soon in the world of prostate cancer. You did (presumably) a sufficient amount of research on deciding to have surgery, so you can (if desired, and it sounds like you are of interest) enter into the next chapter of education and research to explore the cancer outlook after surgery. I would think you would get a PSA test every month (there is no harm in drawing blood and getting a measurement) and then you will have multiple data points for consideration.

Even if your PSA rises in the next few months, it will need to rise to a minimal level (2 or so) in order for some of the imaging to have a degree of confidence.

The heterogeneity of prostate cancer is such that your path forward will be similar, but not exact to other people. So, take your time on education and research, and continue to enjoy a successful recovery from the surgery.

Many data points in PCa; all are relevant, but all are not determinative.
WTH does that mean? The future will determine.

My PCa graded 8s & a 9 at biopsy; G 9 downgraded on 2d opinion review to G 7 (still had 8s); postop stage regraded back to G 9. Clean margins, seminal vesicles and lymph nodes. BUT extraprostatic extension (EPE or ECE) w/ G 9 foretold 1st postop PSA failure at .19 (Biochemical recurrence or BCR).

Rad Onc recommended salvage radiation together with short term ADT (see SPPORT trial). Completed salvage tx and 1st post tx PSA 6 mos later undetectable at Quest Labs sensitivity of < .02

I asked the Rad Onc (center of excellence) about sending pathology material for a Decipher test and he said that it would not alter his treatment recommendation, and we didn't.

I think that a Decipher score may be most helpful in determining initially what tx, or surveillance, is chosen.

After RP or Radiation/ADT, I think that the actual disease course will dictate the direction of additional treatment.

I hope so, and hope more that I never need to find out.

Realistically however, the G 9 and EPE, and BCR, predict additional future treatment will be needed for me.

Very glad your recovery from surgery went well (as did mine), and you (and I) never see PCa "darken my door again".

I have extraprostatic extension as well. Just got the results yesterday. With it being the weekend, my time will be spent learning more about EPC on the internet. Physically feel great but the initial report has caused some mental anguish. Will continue to stay positive and beat this crappola! To your health!

Can you communicate with your surgeon via email? Acknowledging your anxiety snd providing information based on your concerns does not require an in person visit or physical exam.

A good surgeon will know that their patient's state of mind is important in healing and recovery.

I already did. However, I saw the results late yesterday and the office was already closed for the weekend. They are great at communicating so I’m sure I’ll hear from them next week.

In response to @edmonds1971; a PSA reading of .200 is normally considered a sign of recurrence after surgery although some urologists become concerned with a reading of .100 so you have a ways to go. I am not familiar with the impact of the Decipher test. A PSMA-PET scan at .200 has a low likelihood of detecting any cancer. The likelihood of the PSMA detecting cancer increases as your PSA increases from .500 to 2.0. The dilemma is that an early scan might not detect anything but if you delay treatment the cancer may have spread.

Layman advice: Try to take a deep breath and relax.

EPE is a negative indicator for biochemical recurrence (BCR). And it may or may not be a factor in your future.

Best wishes.