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Decipher, SelectMDx, and 4K Score in Active Surveillance & Intermediate Prostate Cancer | PCRI
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- Опубліковано 17 чер 2022
- Medical Oncologist, Mark Scholz, MD, answers patients' questions about the genomic tests used in prostate cance. One, SelectMDx, that is used to determine if a man with a suspicious PSA or DRE needs to investigate further with an MRI or a biopsy, and another, Decipher, which is sometimes used to determine whether a man with a borderline case-usually Gleason 3+4-needs treatment or can pursue active surveillance.
0:09 Does an unfavorable Decipher score mean I need to go off of active surveillance?
2:07 What does my SelectMDx score mean?
4:41 Is there an argument for just going straight to an mpMRI and forgoing tests like SelectMDx, 4K, etc?
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Husband here. 71 and PSA of 6.0. A 4KScore test of 1 percent permitted me not to move on to a biopsy or MRI.
active surveillance
FollowUp: Husband here. Now 73 years old. I had an ExosomeDX test which was 30, and so it was above the safest standard. I then had a multi-parametric MRI, and that was negative: Pirads 1 for peripheral zone, and Pirads 2 for transition zone. So, considering my age, no biopsy for me. I will reconsider repeat MRI in a few years, but just active surveillance.
Very valuable information!!! Thank you all ! Hal.
I was doing routine check ups and got PSA level elevated. Doctor advised to do ultrasound in which size is normal but rough exterior, uroflowmetry normal ,MRI detected that growth has breached the prostate capsule , staging T3 a PSMA pet scan shows no nodal or distant disease . Staging t3 In biopsy report num of positive cores 6, Total num of cores 14, positive cores have 20%. Would like to do proton Radiation. Are hormones required in addition? would prefer to avoid, if possible. Pls advise
PSA (optional) - 8.13
Gleason (optional) - 3 + 4 = 7
Unfortunately found out getting seect mdx test did not expect to get medical gown before test must get dre exam for a better test other tests exodx do not require this minor inconvenience the nurse knew it now I know
Yes, ExosomeDX is a breeze, and you do it at home. A simple urine sample that you mail back.
Okay here is my question: I have an elevated PSA with negative DRE and just got a 3T MRI which came back saying “no lesions detected.” My urologist says that now I need to have a systematic biopsy in order to be confident that I’m cancer free. Do you agree? What I’m reading is that a systematic biopsy after a negative MRI will find clinically significant cancer 5-10% of the time.
The standard recommendation is to have a 12-core biopsy if an mpMRI fails to find a lesion. Dr. Scholz has said in another video that in most of his patients, he recommends another mpMRI a year later to see if there are any changes. He said that typically if an MRI fails to detect an aggressive lesion, it is because it is too small to be detected, and a follow up MRI will be even more informative than the first one because they can compare the second MRI to the first and see if there has been any abnormal growth. However, he does send his patients to UCLA, which has a great radiology department and is one of the best hospitals in the world, and the standard recommendation is still to get a 12-core biopsy.
Regarding your comment about active surveillance at John Hopkins on another video: I am not sure about the details of how/when those numbers were pulled, and I am not currently able to access that study, but Dr. Klotz has several videos in which he compares and contrasts different active surveillance programs around the world. Many of these programs--including Johns Hopkins'--began when not very much was known about the specifics of active surveillance. Each program had its own criteria and Johns Hopkins' program had the strictest criteria of any of the active surveillance programs; for example, only men with a very small volume of Gleason 6 (no more than two cores) were considered acceptable candidates, whereas now we know that any volume of Gleason 6 is acceptable. I don't the exact criteria they used to trigger intervention, so take this with a grain of salt, but that may have included having more than two cores of Gleason 6 (which I am guessing based on their initial criteria) or a rising PSA (which was a common trigger in the past, but now we know that it is not a reason to take someone off of active surveillance). Moreover, generally, the most common reason why people on active surveillance decide to opt for treatment is anxiety. So, I would need to see that specific study to confirm, but I wonder if all those people who went off active surveillance did so for legitimate medical reasons as we understand them in 2022, or how many of them had intervention because of anxiety or because they no longer met criteria that we now know to be outdated?
So, it is possible for someone diagnosed with Gleason 6 to harbor higher-grade cancer, but it is also possible for someone without Gleason 6 to harbor aggressive prostate cancer or for anyone to harbor cancer anywhere in the body, but it is not standard to take random biopsy samples from all over a person's body to see if there is a needle in the haystack somewhere, and it is not standard to treat someone for aggressive cancer that has not been diagnosed. The probability of a man harboring Gleason 6 prostate cancer is his age as a percentage (e.g. 70% for a 70-year-old) and many men will never know that they had Gleason 6 prostate cancer and it will never be recorded in databases. Gleason 6 prostate cancer can, however, confound the regular means of screening, like the PSA and the DRE, and so that may be the best reason to use enhanced screening methodologies like repeat MRI, repeat biopsies, or some of the genetic tests that are available nowadays.
It would not be an issue if treating prostate cancer was a harmless endeavor, but the most common treatments, radical prostatectomy or radiation, are associated with a significant risk of side effects, which we have a lot of videos about. So even in the worst-case scenario, that is, that 42% of men go off of active surveillance because they had a repeat biopsy that found Gleason 7 or higher, that means that 68% of men will never have to subject themselves to a serious risk of incontinence (via surgery), impotence, or strictures (via surgery or radiation), and 42% of men will be able to delay the risk of those side effects. And, keep in mind, that if every man was getting screened and biopsied, the percentage of men who would be diagnosed with Gleason 6 prostate cancer would be huge, and so that would be 68% of a very large number of men who are being spared side effects that can have a tremendous impact on their quality of life.
Our patient advocate is the best person to talk to (RE: our organization) if you have questions about active surveillance. Our contact information is available at pcri.org/helpline. The best I can say is to do your own research (which it seems you are doing), talk to your doctor about your questions and concerns, talk with prostate cancer and active surveillance-oriented support groups (for example, aspatients.org/ and ancan.org/) since you can get the perspectives of men who have been on active surveillance and men who have been treated, and then decide for yourself whether you would rather cope with a level of uncertainty that implicitly exists for people in general--but is not usually laid out as explicitly as it is when someone has Gleason 6 prostate cancer--or whether you would cope with the potential side effects of treatments.
@@ThePCRI thank you for the amazingly informative reply!
Markus -How did things turn out for you? Did you end up with doing a biopsy, after all? I have a PSA of 10. My MRI was "indeterminate" as I have a metal hip which blurred images. However, it did find a small lesion --but was not able categorize it. So i'm debating on getting a biopsy. Meanwhile -I am going to ask my primary care doctor for a 4K test. Have you taken that btw?
Yes a negative dre is great looking at a possible biopsy cause of low free psa# percent my Dr . will definitely sway towards test if I get a abnormal dre for sure
I agree letting the bioppsie have a chance to find cancer is good
My urologist has ordered a Decipher genomic test post biopsy... The biopsy was transperineal ultrasound targeted and was 24 core samples of which 2 in the same location were Gleason graded 4+3.. 25% of tissue ... There were 3 samples that indicated 3+3 and the rest were benign.. You mentioned that the Decipher test may tend to have a negative bias and that concerns me... The biopsy was taken based on a MRI that showed a Pi Rads 4 lesion.. I appear to be on the border between A/S and treatment.. Is there another test out there that can give a definitive answer as to what would be the best course of action???
Dale, How did the Decipher Genomic test come out? In my consult with an Oncologist, I was told that there were two others... Prolaris and Oncotype DX. Thanks, Steve
@@stevehall8345My Decipher score came out very bad, but I had a second opinion on my biopsy from John Hopkins who amended my Gleason score to a 3+4 ( favorable intermediate )… Other medical conditions have complicated any treatment decision for the prostate cancer… If/when I do get treated, I will opt for SBRT using the ViewRay MRIdian machine… Meanwhile, I continue to test my PSA levels quarterly which have dropped significantly… Why/how?? My urologist has no idea…
Exodx best
I have gleason 6 they sent my biopsy slides off for Genetic testing but the slide sample was to small to get a test . is that a good reason to forgo treatment
I am 66 and have a PSA of 3.3 and a Gleason score of 3+4=7 my Urologist sent my samples in for genetic testing for the one he likes using and twice they could not get a reading. So I’ve decided to have Robotic surgery.
Lord. Who's the good-lookin' woman doing the interview???
You must have vision problems or you're just desperate
His daughter-in-law. She’s taken. Too bad for you. 😄
@@kingz9916 Dammitman.