Cribriform cancer . Newly diagnosed.

Everything I have read said that cribriform cancer is resistant to radiation. And once you have radiation, surgery is off the table. Hormone therapy? I have a great fear of no longer being able to exercise and I have a fear of losing muscle mass. I also like the psychological plus of being cancer free after surgery. I have been healthy, fit and fear the effects of all treatments but nothing scares me like hormone therapy.

Thanks for your input.

Cribriform pattern is definitely a more aggressive type but even that is broken down into intraductal and acinar - the first being even more aggressive.
Also, the amount you have in your gland (which no biopsy can show since it only takes a small sample) is also important.
It sounds as if you have decided on surgery and that probably removes the biggest obstacle we all face: the treatment decision…so good on you!
Your surgical pathology will be very important and its analysis will provide your doctors with a plan going forward. Since cribriform is associated with higher rates of BCR regardless of either treatment type -surgery or radiation - you really should confer with more than just your urologic surgeon after your procedure.
Get the opinion of a genito- urinary oncologist who may view your surgical pathology report and recommend ADT and radiation REGARDLESS of your surgical removal.
Surgeons will always say their procedure was 100% successful and they “got it all”.
They will recommend you wait “to see what happens”.
However, not all cribriforms are equal and if yours is of the more aggressive type, treatment now rather than later might be advisable. This is why many RO’s treating cribriform use a brachytherapy boost of high dose radiation into the gland to give it a greater killing potential than even SBRT can offer.

Yes, I am old 2.
My doctor told me about the risk of incontinence at my age (now76) and I decided I didn’t want to wear a diaper for the rest of my life. Now I am on ADT.

I also had cribriform with my Gleason 7 (4+3). Mayo told me I was still an ideal candidate for TULSA Pro. I was 65 last July when treated. I know there are not long term results on Focal therapies yet but the 30 month data looks just as good as the other treatments with far better side effect results. The fact that all other treatments are still available to me if the cancer returns made TULSA a great choice for me.

At 78, I chose surgery after a Gleason (3+4=7) biopsy. Your good health, your surgeon's experience and myriad other factors specific to your diagnosis are crucial factors but NOT your chronological age, in my opinion. Here below is a link to my previous, more detailed, Comment I posted to the topic "Is 76 years old too old for surgery". Since I made that Comment, my PSA has remained undetectable and I feel even more confident that, for me, surgery was the right decision. Best wishes to you for a successful outcome whatever treatment you choose.
https://connect.mayoclinic.org/comment/1075893/

I offer this not to be boasting, but to share the conversation I had with two surgeons @ age 74 when biopsy showed the same as you (4+3, etc) 2 years ago. "Normally I would't suggest surgery, but in your case..." and then they ticked off all the reasons they thought my system might tolerate it: normal BMI of 22, no problems with heart, lungs, liver, kidneys, diabetes, blood pressure, neuro degenerative disease; no prescription meds, fitness equal to someone 20 years younger (exemplified by completing my 30th Ironman in Hawaii 6 months prior). I did have surgery, used no narcotics after leaving the hospital after 24 hours, return of full bladder function after 3 months, full sexual function after 7, and PSA < 0.02 over the subsequent 2 years. So, yes surgery *can* be an option for those of us in our mid-70s, but it *always* carries risks. My own decision was influenced by my father's death from prostate cancer 8 years after radiation treatment @ age 72, who was in similar outstanding health...no meds, daily vigorous activity, no medical problems. He lived in a remote location before the advances of both surgery and anesthesia over the past 30+ years, so that drove his choice.

There's no universal right answer. But I would be leery of surgery had I not been so physically healthy. Even then, I knew the risks. So far, it was a good bet...so far.

Great that you were able to respond so well to the surgery. I am sure your father’s outcome from radiation had a lot to do with it.
But I would venture to guess that he had it done years ago before SBRT, 3TMRI and PSMA PET scans which we all take for granted.
Imagine being an RO 30 years ago - talk about shooting blind! We are all truly lucky to be living in this era of cutting edge medical technology. Maybe 30 yrs from now the technology may be even more than we can even imagine now. Best
Phil

Are you sure of this?

I was working under the following assumptions:
1. Cribriform tumors have increased resistance to radiation (especially HDR brachytherapy alone).
2. Combination therapy (HDR + EBRT + ADT) is the best approach for controlling the disease.
3. Dose-escalated EBRT (>78 Gy) improves local control.
4. Darolutamide and/or Firmagon may help enhance radiation response.
5. Longer ADT duration (6-12 months) is beneficial. I am on an 18 month regimen

Thanks for your input. I am seeing for a consult a physician from Sloan Kettering and then someone from N.Y. Langone…the founder of Cyberknife. Both are NCI designated centers. My decision has not made yet …still open to radiation.

For unfavorable intermediate- to high-risk prostate cancer with cribriform features, the most effective treatment combines:

External Beam Radiation Therapy (EBRT)
Brachytherapy (Boost)
Androgen Deprivation Therapy (ADT)
Possible Addition of Androgen Receptor Inhibitor (ARi) like Darolutamide