Validity/weight of Artera and Decipher Tests

I have consulted with 3 different centers of excellence (UCLA, Univ of Penn & Fox Chase) and all of them said the decipher wouldn't help at all because they were going to treat the same way no matter what the test result, HDR Brachytherapy, 5 sessions of Proton / SBRT or 23 sessions of IMRT and short course of ADT 4-6 months. Of course treatment done with rectal spacer & fiducial markers. I'm sure all these tests are a good tool and a piece of the puzzle for most but not in my case.

@copyman Exactly! Sometimes these tests are very helpful in a gray area - but in a clear cut clinical case, treatment is going to be ‘standard’.
I hear it over and over and over again that men don’t want ADT - who would? But when stacked against cancer - which could kill you or ruin the rest of your life - I just don’t get the head scratching. Do you want to KILL this thing, or not??
Sounds like your treatment plan is comprehensive and the docs are leaving no stone unturned. Best going forward,
Phil

@copyman
If you have an aggressive case with a higher Gleason score, then treatment won’t be different with a decipher score.

If you are 3+4 or 4+3 without any aggressive issues and the decipher score can decide whether or not you need ADT.

I know someone with a 3+4 and large cribriform That has gone two years without any treatment at all with approval for multiple doctors because his decipher score and Artera AI score are both very low. Those tests can make a difference for some people.

@jeffmarc I understand and why I asked all 3 doctors for the tests. But since I was unfavorable intermediate 4+3 with clear PSMA & MRI but high PSA they all told me decipher wouldn't change the treatment which was basically all the same, HDR Brachy, 5 sessions of Proton / SBRT or 23 IMRT sessions, & short course of ADT (4-6 months). You would think they were paying for the test. I found it strange all 3 COE's suggested the same treatment and said no to the decipher. I'm sure I could of insisted on test but when 3 top RO's said it wouldn't matter in my case plus even Dr Scholz on video consult said same thing I stopped asking. Perhaps because it was only a short course of ADT suggested is why they said decipher test didn't matter. I would of insisted on tests if they suggested a longer course of ADT!!!

@copyman
I can understand why They came up with the same requirement for ADT because of the high PSA, it is highly recommended. That short, the time is no big deal.

The thing is, you probably would like to see the results of a decipher test on your five or 10 year reoccurrence chance. You might ask your doctor to have one done so you can at least find out that information.

@jeffmarc Good point. Thanks Jeff I'm going to insist on the test at some point. Does it matter when I get the test, before or after starting treatment? Or does the test use my previous biopsy slides so it wouldn't matter before or after treatment starts?

@copyman
You could wait, but unless you’re having a prostatectomy and have tissue from that, then it will come from your biopsy. You’re having radiation so timing is irrelevant.

If the docs all say the test would not affect their treatment decision, there is a question as to whether any insurance would pay for it. I think the bill submitted to Medicare for my Decipher was $5000. I don't know what they actually paid.

When I asked my RO about the 2 years of ADT he was at that time prescribing for my case, how much of a benefit will that give me, his answer was 15%. I'm not sure exactly what that means even now, whether its 15% more patients with my staging and treatment plan last longer before recurrence, 15% longer life span, or whatever. However, it isn't like submit to ADT or die.

My plan was to research whether 2 years had a lot of data supporting it, and whether alternate treatment proposals came along with shorter periods of ADT. I found promising evidence that changing the treatment plan by adding a brachy boost would mean that 1 year would be as good as 2. My RO did alter the treatment plan, and he has mentioned "maybe" he'll go along with the 1 year.

In any case, if my ADT side effects get unbelievable and unacceptable, I'll drop the Orgovyx I'm presently taking and try Estradiol.

Another thing I've bought into are the ideas of Rob Newton. He is a pioneer exercise oncologist who says he has solid evidence that specific exercise regimes can counter, or substantially ameliorate "all" the side effects of ADT. He's been studying the effect of exercise on prostate cancer patients for more than 20 years. So I'm doing my best to understand what it is that he would prescribe in my case and doing it.

So far, I'm 6 months in on Orgovyx and I'm doing great. I've had intermittent severe joint and muscle pain that has now disappeared completely, a bit of brain fog in the first month or so that is gone, and that's it. I'm concerned about developing bone loss that I have yet to experience symptoms from, but I am going to keep monitoring with tests to see what is happening, and try Newton's prescribed exercises aimed at heading it off.

@jeffmarc The test can be done anytime. However, as climatetguy stated it probably needs to be done before treatment to get paid by insurance. As insurance companies like to say "not medically necessary" when refusing payment. They do not know if the doctors will factor the test into treatment decisions. Assumption is they will if done before treatment. They know they will not if the test is done after treatment.

@fiskadoro Since the doctor wants to put you on doublet therapy (ADT+ARPI) he must think it is aggressive. Most patients do not get Erleada in the initial hormone treatment. Unless this doctor is way out in left field (everyone else says it is not required) concentrate on minimizing the side effects with exercise and diet. The younger you are and the less time on ADT the better the recovery. You are young for prostate cancer so should not have any long-term effects if you work to minimize losses while on therapy and question the benefit of staying on the therapy after 1 year. Studies have shown the vast majority of the benefit occurs in the first 6-12 months so may not be as much objection from your doctors to a shorter course of treatment vs. no treatment.