How do you counsel a patient with NCCN favorable intermediate prostate cancer but a high risk Decipher score?

Active surveillance has become the preferred management strategy for most men with low-risk prostate cancer and is increasingly used in carefully selected patients with favorable intermediate-risk disease. However, men with IR PC have approximately a three-fold greater risk of tumor upgrading or pro...

I tell them the test is somewhat new and based on the genetics of the tumor, and read them what the test says: that it’s recommending combination radiation and ADT.

It’s important to consider how these tests were developed, how we determine staging, and the role of staging. DECIPHER was developed fr...

Any biomarker is not a perfect predictor and must be used in the context of all other information. How high is the Decipher (.61 vs .99)? Also get the Decipher "GRID" score - PTEN, RB, luminal, etc. How much of the biopsy is pattern 4 (5% or 40%), and importantly, what is the pattern 4 histologic su...

Genomic testing for NCCN favorable intermediate-risk prostate cancer is not recommended routinely for all patients. It should be ordered selectively, only when the result could change management. (Eggener et al., PMID 31829902, Eastham et al., PMID 41988960)

I do test it if a favorable intermediate-r...

Even without cribriform pattern or intraductal carcinoma (IDC), a high Decipher score still leads me to advise against active surveillance and strongly recommend robotic radical prostatectomy, assuming the patient carries an acceptable anesthesia risk. With the adoption of “hood-sparing” techniques,...

For men with GS 3+4 and PSA <10 and men unsure about treatment or AS, I'll often use Decipher as a 'tiebreaker'.

For men with low Decipher (and/or low Artera), that result can add confidence to pursuing surveillance.

For men with high Decipher it is a bit of a gray area. We currently have the SUGAR st...