Why are urologists dismissive about Decipher?

Decipher wouldn't have been very relevant for me — since my cancer had already metastasised, there's no need to assess the metastasis risk 🙂 — but on general principle, I'd back the oncologists over the urologists.

topf, urologist determine if you have cancer and send you to radiation or surgical oncologists who help decide on treatment. Treatment recommendations can vary according to decipher or other brands of somatic testing. With prostate cancer the changes are usually about the usefulness of ADT.
For my non-prostate cancer genetic variations had been tested against the same genetic variation in other people. National 1 LLC genetic testing told me that the chemotherapeutic agents prescribed were not effective against my tumor's genetics. It advised me that there was a clinical trial with a newer agent that might prove effective.
If you ask for the full grid on your Decipher result, you'll see how much more information is obtained from the biopsy than just metastatic risk.

In my understanding, only "medically necessary" procedures are covered by our taxpayer-funded medical care. I asked my oncologist about Decipher test. I was told it's done for high risk patients; It was indicated to me that I didn't need it because I wasn't high risk. I didn't argue with my oncologist.

Huh , our urologist tried to avoid Decipher and told us the opposite than what your oncologist said , that since my husband has cribriform and needs treatment Decipher is not needed - his active surveillance was over so no need for Decipher. We insisted of getting Decipher and told him that we will pay for it if it is not covered. It WAS covered in the end. Yesterday we had consult with oncology surgeon and he looked into Decipher, so I guess it was good to have it. I think that it could never be "too much information" when any disease is in question, not to mention cancer.

You did have a Gleason 8 and about half the cores have something in them. That is already aggressive so having a decipher score is not as informative and may not change treatment plans.

Sorry, I dont agree with your doc- I am a 3+4 and my oncologist highly recommended it after reading up on it and talk other experts in the field, they ALL recommended going for it. As far as cost Decipher a policy, they will cover $395 of the total cost, and they also have a plan where they dish out more money. They were very good at putting my case with the insurance company, who eventually picked up the entire cost.

Hope it helps and good luck!!

The urologists also told me that Decipher was developed for liw risk patients to determine if they could go on AS. I understand that it dors not affect how surgery is conducted, but it seems they fon’t even think that it has an effect on overall prognosis.

My experience was the opposite. Following my biopsy at the urology clinic, they automatically forwarded my sample to Decipher for testing saying this is their usual routine. Later when I was discussing my situation with the RO, he seemed to downplay the Decipher results and recommendations even though those results put me in the high risk category.

Most urologists are surgeons. They could care less about aggressiveness based on Decipher - they are cutting based on Gleason Score - PERIOD.
RO’s, however, used Decipher primarily to access whether ADT is necessary as part of their treatment. The higher the Decipher, the greater the need for weakening cells predisposed to metastasis. Remember, radiologists leave the gland IN, and if the PCa isn’t eradicated on the first go round, retreatment becomes more challenging. Hope this helps.
Phil

I think one of the problems is that decipher is just a partly open black box. Yes they publish some stuff, but it isn't like Mayo or some other place like NIH is saying all the genetic factors are exactly what decipher says after pouring over tons of data and looking at thousands of patients. It is a semi-closed, semi-open black box.