How are you using the Decipher score in the definitive setting for prostate cancer?

This is an excellent question.

Before I can answer the question directly, you must ask yourself: how do you currently decide who to give ADT to with RT?

The easy answer is that you use RCTs to choose who to give short-term and long-term ADT to. However, I wish it was that easy.

Lets take RTOG 9408- It included low, int, and high risk men. Overall is showed a DMFS and OS benefit. So do you give short-term ADT to low risk men and all int risk men? I hope not.

Lets take RTOG 9202- It included unfavorab...

Like all tests, I order Decipher when it can potentially change management. And those scenarios are usually centered around systemic therapy like ADT, most often in intermediate-risk disease, and sometimes in high-risk disease when the appropriate intensity of systemic treatment is uncertain. I also interpret Decipher in the context of baseline clinical risk. It provides additional biologic risk stratification within a clinical-risk group, but it does not define absolute risk by itself. A low De...