Dr. Phillip Koo:
Hello, welcome to Prostate Cancer Patient Voices. Today we're kicking off a three-part series covering the topic of Decipher testing and the impact it has on your care.
So when you're diagnosed with prostate cancer, that's really just the beginning of a series of tests that really can help inform how best to manage and treat your disease. And today, to talk about Decipher testing and this idea of risk stratification, we have with us Dr. Eric Kim, who's the chief of urology at the University of Nevada, Reno and Renown Health. So welcome, Dr. Kim.
Dr. Eric Kim:
Hey, Phil. Thanks for having me.
Dr. Phillip Koo:
Risk stratification is something that we often discuss amongst physicians. What do patients, can you explain what that means for patients?
Dr. Eric Kim:
Yeah. The way I tell it to the patients, we're always just gathering more and more data about their situation. And again, this specifically, obviously their prostate cancer. And risk stratification is just adding all of the data that we can accumulate to figure out how bad of an actor your prostate cancer may be. And so there's been a lot in the press about prostate cancer not being aggressive. You're more likely to die with your prostate cancer than of your prostate cancer. And those things are true sometimes, but the converse is also true. And so really figuring out which prostate cancer do you have. Do you have one that's a slow mover, or do you have one that's going to act aggressively? And that's the key to really managing the patient correctly.
Dr. Phillip Koo:
And that's something that's beyond what we often talk about such as like Gleason score.
Dr. Eric Kim:
Yeah, so Gleason score is obviously kind of the foundation. It's the bedrock of risk stratification, but now we have even better tools. Gleason score, it's wonderful and it's based on pathology, which I again tell the patients your pathologist is human, they're smart people, probably smarter than you or me, but they're just human. So they can miss some things or their judgment may not be completely objective. Whereas now we have a genomic test that can be done on the biopsy tissue. That's an objective readout of what's going on with your cancer.
Dr. Phillip Koo:
That's great. That's great to know that there's something that can provide that extra layer or extra depth of information. So one of those tests is called Decipher. Explain to us what is Decipher testing.
Dr. Eric Kim:
So Decipher is a genomic test, and so it looks at the genes in your cancer. And this is, I think, confusing for some patients and honestly confusing for a lot of doctors too. But the cancer DNA is different than your DNA or else it wouldn't be cancer. And so the genomic test is really telling you not about you, not about your family, not about what DNA you have that may have caused the cancer, but actually just looking at the cancer that's formed, what genes have gone wrong that may determine how bad or good this cancer is going to behave.
Dr. Phillip Koo:
You get diagnosed with prostate cancer, who should be getting a Decipher test?
Dr. Eric Kim:
Yeah, it's hard to say that there's anyone that shouldn't. And not to sound too simplistic, but in almost, I'd say at least most cases, the additional data is helpful. So again, tell the patients, it's no skin off your back. There's nothing else that's going to need to happen to you. It's tissue that's already been taken from you from the biopsy that's going to be run for extra testing. So it's painless. It's additional data that'll help inform how to best treat you.
So again, it's hard in my mind to say anybody shouldn't. The only caveat I would say, if someone is sure that they want to have a prostatectomy that they've already decided based on reading, I actually direct a lot of patients to your guys' website, but based on reading or talking to friends or family, they say, "Hey, I already know that prostatectomy is the right treatment for me," then sometimes we hold off and we'll run the test on the prostatectomy tissue rather than the biopsy tissue.
Dr. Phillip Koo:
So that's interesting. So pretty much all patients who get diagnosed with prostate cancer after a biopsy should be considered to get a Decipher test whether you're localized. And does it also apply to patients who might be metastatic at the time of diagnosis?
Dr. Eric Kim:
Yeah, now it does. It really does seem to inform, and I was kind of surprised by that. But it really does inform the decision-making on how to tailor the treatment for, again, like you said, localized disease, trying to decide, "Hey, are you somebody we can just monitor? Do active surveillance for? Are you somebody that we need to consider surgery or radiation right now?"
And then for patients with maybe a little bit more aggressive localized disease, do you need radiation by itself or do you need radiation with some hormone therapy? And then to your point for metastatic disease, who are the patients that need, I don't want to say the kitchen sink, but the kitchen sink? Who are the people that need everything?
Dr. Phillip Koo:
That's great to hear. And that type of information just clearly, it becomes very valuable with what you described in patients who may need more treatment, maybe even less treatment accordingly. So that's great to hear.
So sometimes you can use the biopsy specimens to get the Decipher testing. Sometimes you use the prostatectomy specimen. So after surgery that specimen to do the testing. Are there ever instances in which you would actually get a Decipher test using the biopsy specimen and then do it again if you do undergo a prostatectomy?
Dr. Eric Kim:
I think we're heading toward a culture of trying to spend less money and be a little bit more thoughtful about our resources. So I would say to your point, in most instances, if you already have the Decipher on the biopsy tissue, reflexively getting it again on the prostatectomy tissue won't add a whole lot. It won't change what you already know about the patient.
But I have had some patients that several years after their prostatectomy, they develop a biochemical recurrence or we believe that their cancer may have come back, and in those instances, I'll run it again. And maybe there's a slightly higher accuracy coming from the prostatectomy tissue because you have the whole tumor to work with versus just where we happen to sample.
Dr. Phillip Koo:
So going back to an earlier comment that pretty much all patients could potentially benefit from this type of test, how do you recommend patients go about talking to their physicians about this? Do you recommend as soon as they get diagnosed having this conversation? What advice do you have as someone who performs the biopsies and performs the surgeries?
Dr. Eric Kim:
Yeah, I think it's a good question to ask your urologist, whether it's the initial discussion. A lot of patients after the biopsy results come back, I'll call them, just give a short kind of this is what's going on, a heads up. And then we typically schedule in a week or two to sit down and talk about the treatment options more comprehensively.
I usually like to send it off in that window just so that we have it available to talk about. So again, it depends on, I guess you don't want to offend your urologist. You as the patient I guess need to be careful a little bit. But truly, I think you could bring it up at the time of that initial discussion of, "Hey, we did happen to find prostate cancer," or when and if for however your urologist practices, if you sit down and talk to them about treatment options and they don't bring it up, I think it's very fair to say, "Hey, look, I watched this funny video with this guy named Phil and this guy named Eric and Decipher seems like it might be helpful. Is that something that we should be thinking about on my biopsy tissue?"
Dr. Phillip Koo:
And last question. Oftentimes we get these tests, there's a lot of anxiety waiting for results. I think it's helpful to know sometimes how long does it take to get back those results?
Dr. Eric Kim:
Oh, for sure. Yeah. So the turnaround time I've seen is usually a week or two. That's what I'll tell the patients. But it really depends on your pathology lab because they have to get the physical tissue and have it sent. So some of it is, I guess it's supply chain. It's logistics that really will drive if there's additional turnaround time issues. But it's hard for me to remember someone that was really out of bounds. Maybe two weeks at most, which again, I think that amount of delay is insignificant or inconsequential to the amount of added value of making a better decision.
Dr. Phillip Koo:
So thank you very much for this part of the discussion. Again, I think it's great to know that this test has a place almost for all patients who are diagnosed with prostate cancer and just provides that extra level of data that tells you how aggressive their disease might be. So thank you very much, Eric.
Dr. Eric Kim:
Yeah, thanks for having me, Phil.