Brian Carney shares how Decipher genomic testing provided personalized risk information after prostate cancer surgery, helping him better understand his likelihood of recurrence and guiding decisions about the timing of radiation therapy. He explains how the test's data and visual risk assessment gave him greater confidence in discussions with his care team and reinforced his treatment plan. Brian encourages other patients to ask about Decipher and genetic testing to better understand their disease and make more informed treatment decisions.
My name is Brian Carney, I'm 60 years old. I live in Midland, Texas. I have two kids and I'm married to my wife, Melissa.
In 2024, my prostate had gone up to a three, and my grandfather had had prostate cancer obviously decades ago and I was a little concerned about that. It was attributed basically to the fact that I had gotten one year older, so it'd gone up a point. And my wife was in the hospital in Houston at MD Anderson, so while I was there I decided to schedule a Prenuvo full body scan and it showed a lesion on my prostate.
And so I immediately went back to MD Anderson and they scheduled an MRI, and that MRI showed that it looked suspicious for that. And then subsequently, probably a month later we did, like the end of February, did a biopsy of that. And then that diagnosis came back in March. And then I started down the road of trying to figure out what to do. Where do you go?
After the biopsy, they informed me I had a Gleason score of nine, which made no sense to me at the time, but after I looked at it got me very concerned. Reached out to a friend of mine in LA and they referred me to the Prostate Cancer Foundation. And the people there actually helped me, through them personally and through their materials, make some decisions as to who do you talk to, what do you do?
Went through multiple... trying decision trees, trying to figure out what was best for me. And then ultimately I had surgery in May of 2025. And that actually after they did the pathology on the prostate was a seven, not a nine. But the margins weren't clear. So there was... the seminal vesicles were involved, meaning that the cancer had gone outside the prostate. So then the next question is, what do you do? Do you wait? Do you try and treat it somehow? What are your options? And back to another discussion of, what do you do now?
And at that point, then later in July of 2025, I had read and had some discussions with people at the Prostate Cancer Foundation again, and requested that they do a Decipher test on the sample to see what that would show.
Essentially what the test is, it's kind of a genomic classifier that they take the sample and then they grade it against multiple other cases that they've had before to see what your cells are in comparison to that. So it's a sliding scale. So some it's low risk and then high risk, and based on those cells and other people they've examined before and what their Gleason scores were and what their pathology showed. And so they run that test.
And mine came back basically on the edge of high risk, so it was like intermediate risk, which made me feel better than high risk, where we started. And so mine was... I mean, essentially it's localized on the border of intermediate and high risk, 'cause it's a 0.6. So you go from 0 to a 1.0. So mine was a 0.6, which is just a little over halfway there.
And so based on that study, then there's information that has been gathered and tested to talk about whether or not you can, after surgery, do you do radiation? Do you wait, at what point, to see if your PSA rises to a certain level and then do you do radiation? And what are the success rates before and after that, and historically?
And then another set of numbers that talk about, well, if you have your prostate removed and your PSA rises, then do you do radiation with ADT, which is a drug to suppress your testosterone, which would feed the cancer. And the idea is you starve the cells and then radiate them at the same time, potentially, to get a better success rate. And the Decipher actually would put [inaudible 00:04:56] that decision into the certain numbers, like success rate over a period of... I think it's over... I can tell you how long, I had to look at it earlier. 5 year, 10 year and 15 year risk of metastasis.
So it made me feel better after doing the Decipher that it actually put some quantitative numbers in it, as opposed to someone going, "Well, it might happen or it might not happen. We're not sure." This actually put some hard numbers based on studies, on other patients and their success rates.
I think it's really... I mean, the Decipher report itself is really helpful because, I don't know, a lot of people are visual learners. A lot of people, they like to see a chart or they like to know where things are. And this is... I mean, it shows you your risk compared to patients with similar clinical and pathological features. So they've narrowed down other patients who have similar symptoms of mine, similar test results like mine.
And so basically this chart that they have shows a 10-year risk of metastasis from 2,100 men treated with their prostate being removed, and clinical features similar to mine. And that these patients were 35%, 19%, and 46% were classified as Decipher low, intermediate and high risk.
So they show you those results. It does help you rationalize making a decision. You want to make the best decision you can for yourself in these situations, and there's a lot of information out there. And who knows, you're not trained in it and you don't know so you're relying on the doctors. But this is a randomized number that has been generated from 2000 other men that have a very similar pathology as mine or as a patient being tested. And so it helps figure out which bin your fault that falls into and maybe help you make your decision. Like, can I wait? Should I not wait? How long should I wait?
There's a school of thought that, after you have your prostate removed and if the PSA does actually come back and go up a little bit, that you can wait and wait and wait until it gets to, say, 1.0 before you do anything else. But if you look at the Decipher it talks about... And it makes common sense, if it starts trending up they have better results doing it sooner rather than later. I mean, obviously there's no guarantee to any of it, but I mean, that's what the previous history has shown for a lot of people.
And it helps make your decision, because I think in one hand you want to make sure you do what's necessary to get rid of it. But on the other hand you think, "Well, how long can I wait?" I really don't want to go through any more treatment to... It takes away from your life. You just have a lot of things going on, and you don't want to be premature but you also don't want to be late.
It reinforced what my surgeon had told me, but it also prompted me to find a radiation oncologist, a good radiation oncologist that also would examine this and also agree about... The decision was made that what we'll do is we'll wait just a little bit and see if this continues to trend up. And then if it gets to a certain level, which was pretty low, it was a point like 0.02, a 0.03, that we would begin radiation. Because the idea was your success rate is much better at those lower rates, and certainly don't want to get to a point where it has gotten higher and then you're chasing the disease where it's gone somewhere else. And you've missed it, you missed your window to try and kill it.
It was an added bit of information that helps you, or helped me decide what to do, but also gave me not only the information, but also it was backed up with other people who had been in a similar situation with similar pathology and what the results were. So it wasn't just like an individual study that you went out and read about, that someone used radiation and what happened. This was...
I guess the short answer is yes, it helped. And I think it helped because it gave me numbers that you could easily digest and see and figure out where you landed in this curve.
I would encourage them to get the Decipher testing. I'd also encourage them to get the genetic testing, because it just breaks it down to its lowest level to try and comprehend what type of disease you have and what the outcomes can be, and then also breaks it down in terms of, if you have to do radiation, when should you start it and what are the considerations and the risks potentially of getting it? You don't want to let it get away from you.
And it also helps you talk to your doctor about, "Okay, well what's the timing of this and do we add ADT to it or not?" It's a hard thing when you're not the doctor and you don't know, and I think it helps to give you confidence that you're making the right decision with quantitative findings to help you do it.