Dr. Phillip Koo:
Welcome back to Prostate Cancer Patient Voices, where we are now presenting part three of our series on decipher testing. And in part one and part two we covered what is decipher testing, how it's performed, when it's performed, and how it really impacts your care. And we've seen a couple case scenarios where it really can transform the treatment decisions.
So hopefully we've conveyed and we've shown how important this type of testing can be. And what's nice is patients today are empowered to take care of their own healthcare. And whether it's the patient themselves or their caregivers or loved ones, it's important to speak up.
But part of speaking up is being able to know what questions to ask and being able to have that conversation productively with your treating physician or provider team. So Eric, can you give us some advice and give us some pearls of wisdom on what questions to ask and what conversations to have with your urologist when requesting, receiving, discussing this type of decipher test?
Dr. Eric Kim:
Yeah, absolutely. And thanks for having me again, Phil. Yeah, no, I think if your treating physician and urologist has gotten that decipher, you can always ask for them to print out that score report. It's a very simple document. It helps to maybe frame what that test means, but that's probably the most important thing to ask is to say, "This is my decipher score. What does that mean? Doc, tell me..." And put that into context, within the context of my health as well as the clinical information we have about my prostate cancer, whether you have an MRI already, obviously you've done the biopsy already, you have a PSA level. Just really ask what does this decipher mean in the context of my prostate cancer and what does it mean in the context of my health and my life?
I think another important follow-up to that would be how is this decipher... And this is something to think about, like you said, Phil, it's a two-way street. Gone are the days that your doctor just tells you what you're going to do. It's really a conversation. It's shared decision making. And lucky for us for prostate cancer, we have a huge armamentarium of treatment options, whether it's focal therapy, surgeries, radiation, types of radiation, hormone therapy, secondary agents.
I think that the next question to really ask is, okay, now that we have a relatively well colored, or as best as we can colored picture of my cancer and how it fits into my life and my health, well, what treatment options are best for me? How does this decipher information tell us what therapies are going to work well, what therapies are maybe unnecessary and lead to over-treatment and side effects and harm?
And I think we talked about it in the previous session. It's really, I think, impactful for those men that are thinking about active surveillance. Am I an active surveillance candidate? Is that going to be smart? Are we going to screw the pooch doing that, or is this really a prudent decision? And then for those higher stages, it really tells you how much therapy you need because every therapy has side effects, and it's a matter of balancing those side effects against the benefit you get from the treatment.
Dr. Phillip Koo:
So this is great. I think you've clearly shown how all this information really impacts the decision-making, the discussions, and it's not always cookie cutter. So what's your approach to second opinions and what advice do you give patients regarding second opinions?
Dr. Eric Kim:
Well, I jokingly say... Because patients most are just so kind and gracious, and so then they don't want to offend you. And so they always say it a certain way. And I always tell them, look, it's America. You can shop at Target, you can shop at Menards. I'm not offended. Let me know what they say. I'm also happy to put you in touch with people in my network to get you a second opinion. You don't have to travel to St. Elsewhere. There's also a regional expert that would be good for you to see. I think a second opinion is always good.
Again, the blessing and curse of prostate cancer because it's, I would say less aggressive than some other cancers, you have that time to really make the right decision for you. So you should never feel under the gun. If you feel like your treating physician is kind of pressuring you to do something, I think it's right to instinctually say, "Hey, wait a minute. I just want to gather some more data. I just want to make an informed decision for me." And really, I think any self-respecting urologist should respect that.
Dr. Phillip Koo:
I think that's a really, really great point of advice is you have time and you only have one shot to make that decision, especially upfront. And that really impacts a lot of things downstream. So decipher testing is interesting. I could picture a conversation where a patient walks in says, "Hey doc, I saw this video and they said I should ask for a decipher test." And then maybe the doctor says, "You know what? Don't bother. You don't need it. You have prostate cancer. I'll take it out. You'll be fine." How should patients respond to that?
Dr. Eric Kim:
I think if you've... To be fair to that, that doctor that you painted a picture of... If the patient's most appropriately served and the patient also agrees with doing surgery, you can always run the testing on the prostatectomy tissue. So that answer's not wrong. But to your point, it is a somewhat unsophisticated view.
I think a lot of patients, there's going to be small nuances on how your treatment is approached based on additional data about your cancer. And so I would just say more data isn't going to hurt you. You have the luxury of time to make an informed decision. The turnaround time is usually one or two weeks. I think asking for the test is very reasonable.
Dr. Phillip Koo:
Yeah, I couldn't agree anymore. And to your point of having more data, I think it's really our goal to make the best decisions possible. Nothing's perfect, but every percentage point, every increment of a percentage point that we can put in the patient's favor, whether it's for outcomes or adverse events, I think it's really incumbent on all of us to do what we can to make sure we deliver on that. So I really appreciate this discussion, Eric. Any final last words?
Dr. Eric Kim:
I mean, the only other thing I'd be thinking for the patients to ask along the lines of asking for genomic test or asking for decipher testing is just to again, ask for what are the tests that are going to be helpful for making our treatment decisions? And so there's maybe places that don't have access to imaging or certain imaging modalities or like you said, I don't want to say old school, but an old school urologist that says, "Ah, you don't need that fancy-schmancy test, whatever."
I think it's always fair to ask, to say, I've seen a lot of stuff about prostate MRI. Is that something that we should get, if you haven't already gotten it? I've seen a lot of news about PSMA PET scans. Is that something that I should be getting? Is that something that's going to be impactful for me? And just see what your urologist says or your doctor says. And if you're not on the same wavelength, I think absolutely okay to get a second opinion.
Dr. Phillip Koo:
Just a little side note, I often tell my kids, and we laugh about this, but if you ever hear someone say, "Hey, I've been doing this for 20 years, don't worry about it." Run away. I think, yes, practice makes perfect, but I think medicine evolves and adapts and changes so rapidly that what we did 20 years ago in many ways isn't relevant today. So I think this is a good case in point. So thank you so much, Eric. Really appreciate your insights and appreciate the time and just sharing with the entire prostate community.
Dr. Eric Kim:
Yeah, thank you guys so much for having me. And good seeing you, Phil.
Dr. Phillip Koo:
Likewise.