Cribriform cells: Does their presence change treatment approach?

At the latest PCRI conference this was brought up.

When PSA rises but can’t be found in the PSMA Pet scan, do an MRI, it will be found in Retroperitoneum or lung with high frequency

That is just one suggestion. Some people do not produce PSMA, So a PSMA PET scan doesn’t show anything.

It is recommended that people get an FDG Scan to see if they can find metastasis that are not seen by the PSMA pet.

I’m surprised your doctors let your PSA get so high. They should’ve implemented treatment at much lower levels of PSA, And it’s almost malpractice to not put you on ADT after having salvage radiation With a Gleason nine and cribriform!

The thing is the PSMA pet scan cannot see metastasis smaller than 2.7 mm and even at 5 mm. They are frequently missed. Your husband could have multiple small metastasis that just cannot Be seen, yet.

Where are you being treated? I cannot imagine a well trained oncologist having you have reoccurrences doing Salvage radiation and then not giving you ADT with a Gleason nine. You really need to look for a new medical team. You’ve got a very deadly disease that is not being treated properly. You want to go to A center of excellence or find a Genito urinary oncologist, The ones that specialize in prostate cancer. Medical oncologist treat all different types of cancers so they cannot keep up with the latest things going on in prostate cancer.

Your husband may be a case that Pluvicto could help with. They could find the small metastasis and destroy them. That only works if they have PSMA, And in your case, that is not clear.

Hi and thanks for your reply. He does appreciate that his life span will be reduced if he chooses not to stay on ADT, but having witnessed his sister's tragic and extremely painful death with cancer and her husbands lengthy period when terminal with prostate cancer it does also make you appreciate quality versus quantity of life. He will go back on ADT but needs a break after this last period. It wasn’t just fatigue he suffered with but also extreme pain everywhere. He has high blood pressure (stable for many years on medication) and is now being investigated for angina too since becoming breathless on hormones. It has disappeared again now it’s out of his system. With regards his sex drive, yes obviously we appreciate it’s nothing compared to living longer providing you have some quality of life too, and there’s no pressure there at all.

His oncologists are in a centre of excellence and connected to a good team (now we have moved health boards thankfully). We have no issue with them and they are always available to answer any questions, and when he decides to try hormones again we can mention the options you’ve kindly given me.

They will be monitoring closely the lung nodules, they are all under 10 mm currently but will be checked at each scan now.

Thanks again

Hello, we live in Toronto and my Husband diagnised in early May. Looks like we have to wait 6 plus months. Very scared... just dont know what else to do to speed up the process. Any advice will be greatly appreciated. BTW how do I DM you?

Hello, can you please tell me how to get into a cancer centre? Does my family doctor have to refer me? Thanks!

My path into a Canadian cancer centre was atypical — I was already in the hospital system because of emergency spinal surgery, so sending me to the affiliated cancer centre was just an internal transfer.

But you should have some say in where you're treated. If you're already diagnosed, I'd think it would be your urologist or oncologist who'd be best able to help you get into a major cancer centre attached to a teaching hospital in a different city. They'd have to put together a full package of your imaging, pathology reports, etc. and refer you there. But best to talk to your current cancer treatment team directly.

Do any other Canadians here have suggestions?

To DM me, click on my user name on this message, and you'll see a link "Send Private Message" right under the avatar.

Yes, the waiting must be frustrating. They took me fast because my cancer had already spread into my spine and was immediately life threatening (I'd lost use of my legs before they operated, though I have most of that back now). If they're making your spouse wait, the odds are (I hope) that it's a very early stage diagnosis, and there's no immediate threat. Still, I hope you know more soon.

Thanks so much for replying Sir! appreciate it!

Thank you for replying! My Husband has a PSA of 8.5 and Gleason score of 7 (3+4) GS4 being less than 5%. Contained in both side prostate. My Urologist is one of the best in Mississauga where I live. While some surveys indicate wait time of 6 months for GS 7 should be ok, other surveys say time does matter, even a few months in the final outcome.. I hear that North York Hospital has least waiting times, so trying to check that out tomorrow. Advice from Canadians on this forum will be much appreciated.

I would also like to know if there is any treatment (oral medication) that he can take while he is waiting for surgery? My Urologist has refused saying there is nothing he can prescribe during the waiting period. I read someone's comment here saying that he had started ADT in the waiting period of surgery. Dont remember who...

My understanding is that yes, one can start ADT to stop cancer growth but somebody here also mentioned that it can change final pathology report. Please check about that and this would apply only if your husband is planing to have a prostatectomy. If he plans to have radiation I think that starting ADT would even be beneficial. You need to find a specialist for prostate cancer, regular urologists are often not equipped to give valid advice.

PS: I also found studies that showed that 6 mos made no difference in low and intermediate cancer growth, BUT, I can understand your plight - my husband was diagnosed in March and we had to wait for every app. for eons. He will have surgery NEXT month *sigh ... And yes, we live in the USA.

PPS: Regarding PM , if you just made your profile, you will not be able to send any (you can receive them though) until some "initiation" period passes.