Validity/weight of Artera and Decipher Tests

You aren't the one missing something. Both tests are worth the wait. Decipher can help you determine the usefulness of hormone treatment. They won't send you the entire grid unless you ask for it. The tests have different revelations. Artera is more comprehensive generating information on both somatic (genetic mutations of the tumor) and genetic yielding the genetic vulnerabilities and strengths that you are born with.
The hematologist might have experienced knowledge of medication most successful in patients with what they know of your cancer. And they may not take note of your Artera or Decipher results. You've probably already looked at both websites https://artera.ai/for-patients https://www.veracyte.com/tests/decipher-prostate/
Two things I mention somewhat extraneously
Two months on Orgovyx ADT reduced the size of the tumor by almost half. In my personal experience, with a different (not prostate) cancer, having somatic testing of the tumor itself saved me the the experience of three chemotherapeutic agents, all of which would have had unpleasant side effects, and all of which had been determined to be ineffective against my mutations.

Some doctors really do like the tests because they can differentiate between those that need ADT and those that don’t. Other doctors are just not up on what’s going on as much. The same thing is a problem with medical oncologist. If they have not been trained as Genito urinary oncologists Then they don’t specialize in prostate cancer and don’t keep up with everything going on. They do work with all different types of cancers so they can’t specialize.

I know one guy who has only a Gleason 3+4, but he has large cribriform. His decipher and Artera tests are both very low. He is now in his second year, waiting for treatment because he doesn’t feel he needs it yet. He has seen multiple specialists and they all agree with him, even Dr. Epstein Who specializes in second opinions of biopsies.

Good to hear you are seeing other doctors and can probably get the tests from one of them.

Well you know PCa is driven by thousands of genes it is believed, and Decipher only tests 22. I would feel a heck of a lot better if they tested 483 or 948 or some higher than 22 genes to come up with a score. It also hasn't upped the number in quite some time, or many many years have gone by and no more genes added to their test. It is a speculation call with maybe 2% of genes trying to call something, but they do it with the stock market, lottery, drafting football players, everything is a bet sort of.

I don’t think it’s about “giving little credit to the two exams.” It’s about not getting a test simply for the sake of getting a test.

You have to consider how the test results may change treatment management. There are many different biomarker tests depending on what you’re looking for:

> FoundationOne®Liquid CDx; Guardant360; Caris Assure.
> Decipher; Prolaris; OncotypeDx.

Liquid biomarker tests:
> (blood): 4KScore; EpiSwitch PSE; Phi Prostate Health Index;
> (urine): SelectMDx; PCa3 (PC Antigen 3); MyProstateScore (MPS), ExoDx.

(I’ve probably missed others.)

So, it depends on what biomarker information you’re looking for and what you plan to do with it. (I had the OncotypeDx and Prolaris tests; never had a Decipher test.)

On the other hand, you shouldn’t feel rushed. You should expect to get all your questions answered - sometimes the answer may be “no”, if they can explain why (or why not). But, even if they say “No” to ArteraAI (as just one example), if you still want the test, they should arrange it for you (if insurance will pay for it).

(I had 28 sessions of proton radiation with 6 months of ADT. Treatments were relatively uneventful.)

@bjroc
The decipher test is not really a genetic test, And does not test for Genetic anomalies. People should also get an hereditary genetic test.

Decipher tests the genetics of the tumor. It can tailor your care. It averages whether your tumor is likely to be metastatic, more aggressive. It's a clue as to whether you might watch and wait or whether you should have radiation or surgery, or you really should use ADT or not.
Patients should have hereditary genetic testing. Together these test are most important for any chemotherapeutic applications.

The Artera AI test uses the biopsy material to specifically examine biomarkers to predict the effectiveness of adding ADT to a treatment plan for Gleason 7 (4+3 or 3+4). So, it seems relevant to your decision.

By the way, if they told you your tumor would shrink by 40-50% did they also tell you the same would happen to your testes (speaking from experience)? ADT can be lifesaving when required but recent studies have shown that it has been over prescribed, both to the number of patients and length of treatment for patients that required it. Since you are young for a prostate cancer patient you will probably recover most of your testosterone after treatment if it is short term. May not if it is 2 years. There are a lot of posts on this board that go through all of the bad side effects that ADT therapy has. Even without short term effects such as hot flashes it is hard to even minimize muscle and bone loss while on ADT.

@jeffmarc It is an RNA genetic expression test, or if you don't like the word genetics, call it RNA expression test or whatever. But there are still thousands of genes that they don't know what the expression of those genes do or prevent or help or hinder or make it slow or fast or any other terms, basically they don't know. Yet the money they get at this point should be going to get to know the other thousands of potential expressions and what they do, and it doesn't appear to be doing that as the test hasn't changed in years. It is the same math, just ok you can use differing words.
Also factors alter expression of genes, a bad gene but no factors allowing it to express and it means nothing since the gene expression is hindered. Conversely a not so bad looking gene but lots of factors and the cell goes ahead and expresses a lot and maybe bad things happen. At least what I have read it is too open ended, of course maybe I haven't read enough, but for sure it seems to not be progressing. Sure there is a lot of support since it gets paid for by insurance mostly, but the money going to Decipher isn't making progress since I haven't seem much change.

@bjroc
They actually refer to them as genomic tests, not genetic tests.

I was just trying to make sure people that are not knowledgeable realize that there is a separate genetic test for hereditary genes, Or even genetic changes in their tissue or blood with a somatic test.

Decipher measures number of mutations in RNA segments - some mutations have nothing to do with PC so there is no need to check for ALL of the mutations.

Decipher measures number of mutations in the sample, "load" if you will. The more "scrambled" RNA is the higher the score.

Decipher will tell how aggressive the cancer is (or the potential of it becoming aggressive in the future) so if somebody is intermediate but has high Decipher it will change the course of the treatment. For example if somebody is 4+3 and low D., that person can avoid ADT, and if somebody is 4+3 and D. is 85, than ADT would be advisable. Same way Gleason 8 with low Decipher can avoid ADT , etc.

@fiskadoro for example has cancer that escaped his gland - it is in lymph nodes and vesicles ! Decipher would definitely help with treatment plan but as far as I know there would be very little chance that he can escape ADT since cancer is spreading : (((. I do not know why they did not suggest very early salvage ( before 0.1 ) with such case where cancer already escaped gland ?

Salvage RT has the best results when it is done before PSA reaches 0.2 , after that success is lower and lower. After 0.5 it is less effective.
https://link.springer.com/article/10.1007/s00345-025-05840-w