Cribriform cells: Does their presence change treatment approach?

Hans, please remember that Association is NOT Causation.
While T is a component of the prostate cancer equation, its presence or absence does not cause the disease - but is associated with its progression or regression. So I do get where you are coming from.
Cribriform cells are a type of PCa cell which are inherently more aggressive from the get go. That does not mean, however, that they will not respond to ADT. And if that is combined with brachytherapy and IMRT, you may well eradicate them.
Start there and then see what happens. This is why this is often called a “journey” - and not a short walk in the park!

I read somewhere that prostate cribriform cannot be successfully treated (killed) with radiation. Is that true?

Cribriform is Found inside the prostate when they get cores or analyze the whole Prostate after surgery.

When you use radiation on the prostate, it will just destroy everything in it, including the cribriform areas. As long as the cancer has not spread out of the prostate.

The thing about cribriform Is that the appearance of it means that your cancer is much more aggressive. It’s as aggressive as someone who has a much higher Gleason score. You want to treat it soon so that it does not spread, getting on ADT while waiting for treatment would be sufficient.

Thanks. Sadly, I'm someone who has a Gleason score of 9, and so with cribriform it's a double whammy. Add in the Perineal invasion biopsy finding and I guess it's a triple whammy. The only good news I've had so far is that there's no evidence of bone or lymph node metastases. My FIRST actual face-to-face appointment date with my Urologist is 10 March. Up to this point (over 14 months since the initial high PSA) I've had 5 PSA tests, a cystoscopy, pelvic area MRI (Pi-Rads 5), CT scan, bone scan, and a biopsy. Current PSA is 12.3. I'm sure there will be suggestive treatment options at the appointment, decisions to be made etc. I just need to get going with some treatment and my patience being tested. I have no idea what that treatment might be.

Urologist do surgery so that is what some of them recommend. You should already have an appointment within a radiation oncologist. Radiation is another choice you should be fully informed of. The two techniques have very similar outcomes. Radiation treatment is less likely to cause erectile dysfunction.

Have you had a PSMA pet scan. With your case, you need To speak to your doctor about getting one. That is the test that shows whether or not your cancer has spread somewhere else in your body. If it has then treatment is different, So you want to know? Many doctor feel that the CT scan and bone scan should be eliminated and replaced by the PSMA pet scan. You can also get a baseline by taking this test now.

Is there evidence the cancer has gotten out of the prostate? If it has gotten out of the prostate, then surgery may not be the most logical first step. You need to discuss this with knowledgeable doctors.

I would recommend that you get yourself to a center of excellence or find a Genito urinary Oncologist, They specialize in prostate cancer so they spend more time on it than a medical oncologist who specialize in everything. You know you have a very serious case of cancer and you want the best treatment. I know Gleason nines that are still around after up to 30 years.

Speak to your urologist about getting on ADT right away. If you do that, the cancer can usually have all growth halted, and in many cases can shrink the metastasis. Many Doctors like to do that before radiation.

Hey Stew, great advice and very comprehensive game plan offered by Jeffmarc. I will add that many hospitals are doing HDR brachytherapy plus SBRT with hormones.
The idea is that the short term high intensity boost given with the seeds (maybe an hour) really gives those aggressive cribriform areas a beat down.
Then, 5 sessions of SBRT (MRIdian, Cyberknife) takes care of the rest of the gland and margins. With G9 ADT is a given…Best
Phil

Wish I had done that.
Interestingly, biopsy noted cribiform but post op pathology did not...
Now oligometastatic, may well have happened btwn biopsy and surgery (3 months)