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Thread: Defining predictors of overall survival for high-risk men after RP

  1. #31
    Quote Originally Posted by Another View Post
    To state in a simpler way, you had no adverse conditions and will not benefit from early (0.03) salvage radiation treatment.

    To further my point of a simple consideration; while having a high G score; you had early detection (low volume) and early treatment.
    Yes, low volume and no real adverse findings (pT2), which reinforces my wanting more "proof" that any BCR is from, or includes, local recurrence before starting SRT

    The low risk may reside in free floating cells which seems to take time to establish and which was/is thwarted by your early detection and treatment.
    Possibly, yes. I might suspect recurrence is metasatic in nature and perhaps non-local . Perhaps I'll need my femur or illiac crest irradiation instead (?)

    What surprises me is the Decipher score and before I relied on it to avoid treatment I'd want it to be based on more population data to establish more certainty. Does a decphher score within an individual's Gleason grade change with time? Or, would your 4 and 5 graded cancer cells have developed the capacity to metatstizise with time with more generations. Does an agressive cell's ability to metatstize increase with it's newer generations?
    These are difficult questions. I believe the validated data is basically sound -- the met prediction covers 5 years. As we know, risk continues way beyond that, but it does start to decrease with increasing years. I think genomics is to new to answer all questions. For example, I don't think we have enough years of data to say patient A is low risk now, but that is likely to change, while patient B is and will remain low risk.

    On the flip side, only two lesion areas are examined for the Decipher test (the worse of the two is reported). Mets generally all come from one lesion, and it could be from a future lesion worse-off genetically than those submitted. I think we'll learn more how representative genomic findings are in coming years.) While my 5-yr met risk was low, it wasn't zero.

    For now, genomics IMO should be considered another data point, a piece of the total puzzle. If it doesn't just add more (welcome) weight to the decision you're headed for, I think it can serve as a tie-breaker if you are "stuck" between two decisions.

    Thanks, Another!

    Last edited by DjinTonic; 07-16-2019 at 06:10 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    2013 TURP (90→30 g) path neg. then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 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 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015


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