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Thread: I am starting to appreciate the prognostic value of Decipher!

  1. #11
    OTS, that is a generous definition of ART. You don't know if your PSA will rise, and if yes, with what speed. You could even have many years before RT, and still qualify for the "ADT" stats if you act below 0.2, which you likely might, depending on your Decipher score.

    Also, even BCR does not necessarily lead to recurrent clinical disease: and SRT could also head it off. When it does progress, it takes an avg. of 5 years.

    On the other hand Decipher high-risk scores are between 0.6 and 1.0 (i.e., they go above 0.75). As I mentioned, if you want to get your ducks in a row now, as it would seem, why not do your Decipher test now?

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) path. neg. for cancer; then 6-mo. checkups
    6-06-17 DRE: nodule R and PSA rise, on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 5% RLM
    Bone scan, CTs, X-rays: negative
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5 x 5 x 4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%; 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 weeks) PSA <0.1
    LabCorp uPSA (Roche ECLIA):
    11-28-17 (3 mo. ) 0.010
    02-26-18 (6 mo. ) 0.009
    05-30-18 (9 mo. ) 0.007
    08-27-18 (1 year) 0.018
    09-26-18 (13 mo) 0.013 (checking rise)
    11-26-18 (15 mo) 0.012
    02-25-19 (18 mo) 0.015
    05-22-19 (21 mo) 0.015

  2. #12
    Senior User
    Join Date
    Nov 2018
    Posts
    220
    I am reading this with great interest. I read my Mayo Dr. visit summary and he noted I was high risk and would be monitored closely every 3 months with psa but for now was cancer free. He did say during the conversation that I could possibly go years before any PSA rise I guess even if I'm high risk. He doesn't want to do a decipher test now. Guess we will talk about that again in September. I will have my PCP do my PSA again in August since he does the uPSA and Mayo does the <.1 Thanks for all the information OTS and Djin.
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Bx 11/2018 12 cores 3 positive one 5% left mid two 50% left base
    Gleason 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews recommend
    MRI 2/27/2019 Mayo AZ
    RALP 2/28/2019 Mayo AZ Dr. Paul Andrews
    Path: Gleason 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents moderate to extensive volume mainly on the
    posterior portion of prostate. Largest tumor nodule measures
    8 mm.
    Prostate: 21g 3.5 x 3 x 3 cm
    EPE: Absent
    Bladder Neck Invasion: Absent
    Seminal Vesicle Invasion: Positive (left seminal vesicle)
    Margins: Positive left lateral base and central base margins 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes examined: 16
    Nerves spared right side only
    Pathologic Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx
    Continence 99% 9 weeks
    Post Op PSA: 4/17/2019 <.1
    2 Month PSA: <.007

  3. #13
    So I have a question for our Mayo Clinic Forum Brothers. First, I'm setting aside the post-RP men who need and are given ART shortly after healing either for high PSA, serious adverse findings with high-grade disease (regardless of PSA), etc. Is it the case that no men receive SRT below a PSA of 0.1? That is the lower limit of detection for PSA used at Mayo, which is why I'm asking. (I assume that the second decimal place starts to appear above 0.1.) What is the lowest (rising) PSA for which Mayo docs will consider salvage RT?

    Again, I am not talking about Adjuvant RT.

    Thanks,

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) path. neg. for cancer; then 6-mo. checkups
    6-06-17 DRE: nodule R and PSA rise, on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 5% RLM
    Bone scan, CTs, X-rays: negative
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5 x 5 x 4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%; 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 weeks) PSA <0.1
    LabCorp uPSA (Roche ECLIA):
    11-28-17 (3 mo. ) 0.010
    02-26-18 (6 mo. ) 0.009
    05-30-18 (9 mo. ) 0.007
    08-27-18 (1 year) 0.018
    09-26-18 (13 mo) 0.013 (checking rise)
    11-26-18 (15 mo) 0.012
    02-25-19 (18 mo) 0.015
    05-22-19 (21 mo) 0.015

 

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