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)

Hi, my husband had a RALP Dec 2023 after a gleason of 3+3 with a 15mm lesion at outer edge of prostate (thankfully we decided against our health authority's advice for just active surveillance). In Feb 2024 our surgeon informed us that the lesion had grown as an extensive extracapiscular adenocarcinoma of 34mm since diagnosis and was regraded to 4+3 with 'aggresive cribriform pattern cancer' 2 other lesions found were minor and of low grade prostate cancer. His PSA post op was 1.9 which rapidly grew monthly.

He had 2 PETCT scans, many mri and bone scans all negative (he unfortunately doesn't react to the Radioactive material used). His oncologist advised to use hormone therapy as sometimes it flags up where the cancer is. He was reluctant to try it initially as he'd recovered fantastically post op, no incontinence etc and didn't want the 'chemical castration'. However, he had no option as the PSA was getting faster in its growth. This did result with a lesion being found on his 10th left rib on his back. We understand cribriform metastises at distant locations.

He had 3 sessions of high focussed SABR radiotherapy on his rib without issue and it looks as if that has worked. He felt dreadful on the hormone therapy and lost all energy and was in constant pain. Its taken him 8 months to recover from the 3 month injection and he's regained some of his vigour and sex drive again. He's also now being referred for angina checks due to breathlessness on the hormones. The flip side being his PSA is now rising again since the hormones have left his body. We saw the oncologist yesterday and she said on his latest CT scan they'd also seen small lung nodules but she doesn't think there's anything to worry about as prostate cancer doesn't go to the lungs. Obviously I've since researched it found that although it's rare prostate cancer can metastisise to the lungs without other bony avenues. As cribriform is relatively new we would like to know if there are more of these rare lung nodules connected to cribriform prostate cancer?

Our oncologist is excellent but we are obviously nervous about these nodules.

Your husband has a very aggressive form of cancer. Unless he stays on ADT or something similar, he is not going to live a long life.

Yes ADT Can cause a lot of fatigue, especially if you don’t exercise regularly. The problem is, without it the cancer will continue to grow, and it will not be pleasant.

You could talk to your doctor about monotherapy, Something like Darolutamide or apalutamide may work to reduce the cancer growth, But unless his testosterone is also managed, those drugs cannot work fully, and his PSA will probably continue to rise, just not as fast.

My father died of prostate cancer. When I was young, he had his teeth ground down and crowned without Novacaine and came to dinner every night, He had an incredible pain tolerance. He died of prostate cancer. In the last few weeks you couldn’t even talk to him because he was on so much painkillers he was not able to communicate.

Yes, ADT has it drawback, I was on it for eight years. I should know. If you can’t handle the fatigue, then you should speak to a palliative care doctor. They will work with him to resolve the problems he’s having with ADT.. Yes, he will lose some of his sex drive if he goes on ADT, But he could live for another decade. What is more important? If they put them on ADT plus abiraterone then the fatigue can be pretty bad, Adding more prednisone can make a big difference, Going to 10 mg of prednisone has helped people I know relieve some of the fatigue problems. ADT with Darolutamide would have fewer side effects. If he is on abiraterone And has heart issues it is not the right drug. I had to quit taking abiraterone Because of the effects on my heart, Darolutamide does not have similar problems.

I’ve heard from multiple people that have had prostate cancer tumors in their lungs. Going on ADT plus an ARSI can reduce those tumors, Had somebody reported they completely disappeared.

It sounds like you need to find yourself a different medical team. Is your oncologist, a medical oncologist or a Genito urinary oncologist? The GU oncologists specialize in prostate cancer and can help you a lot more. Are you working with a center of excellence? Going to a place like that may give you more options.

I have been unable to locate my metastatic cancer after RP and 8 weeks of radiation in the prostate bed and related areas. Lupron worked after 6 months treatment but PSA has now risen to 2.9 with doubling at about a 5 month rate. I am Gleason 9 Cribform, and just tried an Axumin scan after my last PSMA pet was again negative. Still no sign of where the cancer is. In short, despite the aggracivity of my disease, we have never been able to see where it has metastasized. I am seeing my oncologist next week. Is my only option ADT? I can probably live with that, but all I am doing is kicking the can. I have never had any symptoms of prostate cancer and workout regularly. Should I expect to see this cancer on a pet scan if I risk my life further by allowing my PSA to rise to four or five? This is the dilemma my face. Any thoughts would be helpful.