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Decipher prostate test

Yesterday I had a consultation with my urologist to go over my biopsy results. Overall T1c. Cancer cells in 3 out of 6 locations in the prostate. Gleason score 3+3=6, 3+3=6, 3+4=7. I brought up the option of active surveillance and he said it is a possibility, but he is somewhat concerned with the risk of metastasize. He recommended a Decipher prostate test to help determine if I should go with active surveillance. Without thinking I said sure thing. I never even thought to check to see if my insurance even covers it. Medicare does, but I'm 59. I spent all day digging through my insurance booklets and I'm not 100 percent sure. I called the clinic, but was only able to leave a message. My insurance customer service representative couldn't tell me if it was covered unless I had the code for the test. Has anyone else had this test?

  1. I had the Decipher test run on my removed Prostate (post surgery). This was done to better inform my team on a course of action should I have any recurrences. In my case my group insurance thru my employer covered it. However; my employers insurance is highly regarded as having excellent coverage. I think the cost was ~5k$

    1. Hi . I can't personally speak to the use of the Decipher test, but I do want to share with you this research paper which found that "Decipher can be applied to prostate biopsies from NCCN-very-low/low and favorable-intermediate risk patients to predict absence of adverse pathologic features. These patients are predicted to be good candidates for active surveillance:"😧101-6 (note: our system turns an eight followed by a dash into the emoji - if you copy and paste and put in the eight and dash the link should work). Concerning the insurance, obviously I can't speak to your particular coverage. That said, insurance often follows Medicare guidance and according to this page on Medicare coverage criteria for Decipher what you described as your diagnosis would seem to clear fall within the guidelines (if an appeal would be necessary this document may also be helpful): Hopefully others will chime in with their experience. Best, Richard ( Team)

      1. Thanks. I spent most of yesterday researching and reading. I'm about 90 percent sure my insurance will cover it. I have the federal employee version of BCBS. I really would only be comfortable doing active surveillance for a few months. It would be nice to enjoy my summer and teach my class at our local university this fall. If the results of the Decipher test say I'm not a good candidate for active surveillance then I'll make treatment plans sooner.

        1. I had the decipher following surgery and it was determined i was border line - that was in 2013 and we are now into 2022 - fingers crossed

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