How does Decipher score inform your practice for treating pelvic nodes in otherwise favorable intermediate risk prostate cancer?
Nodal radiation therapy in prostate cancer remains controversial. While the Decipher score correlates with lymph node involvement in pathological specimens, I have not used it to decide on pelvic nodal radiation. Two randomized studies failed to show a benefit to pelvic radiation (old studies with i...
There is data showing decipher is predictive for PSMA positive nodes. For UFIR, if high decipher, I consider nodal RT.
It's not unreasonable to use any valid predictor in decision making. I use the Partin tables and MSK nomograms as a predictor of lymph node involvement, and if the rate is less than 10%, don't treat the nodes, and if it's 10%+, consider it. A very high decipher score indicates an increased risk of m...
I would be hard pressed based on current evidence to consider adding LNRT to an FIR patient because of a Decipher score.
I personally go by MSKCC nomogram with a threshold of 15% and have, to date, not met an FIR patient who would meet the criteria. Some UIR patients can meet those criteria without ...