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.

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.

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.

The good news is that Gleason 3+4 is borderline: it's the lowest score that oncologists are even willing to call prostate cancer (it's lower risk than 4+3, which is also Gleason 7).

One likely recommendation is what they call "active surveillance", which means just more-frequent blood tests and scans to keep an eye on it. If PSA hits 10 or so (depending on the oncologist), they might consider trying some medication, but I think it would be less common to jump straight to surgery or radiation with only a 3+4 score.

The other good news is that the long-term survival rate for Gleason 3+4=7 with treatment is somewhere over 99%, I think.

There are probably cancer patients who need treatment urgently being triaged ahead of your husband, so in a sense, it's good news that they're not in a rush to see him, even though the wait is stressful. For me in 2021 it was straight into a hospital bed, being wheeled back and forth on a stretcher for a few days for endless tests and imaging while they tried to figure out what was happening, rushing into the operating room in the wee hours for 10+ hours of emergency surgery, then 3 1/2 months before I was stable enough to be allowed to go back home. Trust me, you don't want to be in a situation where they're eager to take him in a hurry. 🙂

In the meantime, many people in the forum have found this book very helpful for understanding prostate cancer, including your husband's situation. It's well worth a read (even though things have already changed a bit just since it was last updated in 2023.
https://www.amazon.ca/Patrick-Walshs-Surviving-Prostate-Cancer/dp/1538726866

Thank you for your reply! So sorry to hear of your sad experiences. Sincerely hope all will be well going forward. Yes you are right about there being others who need the surgery more urgently than us and I do thank God that our case is not so urgent. My huband is very cool about it, atleast outwardly. Que sera sera. I am the worrying proactive one trying to find answers. In the meantime keeping my fingers crossed.

The good news is that Gleason 3+4 is borderline: it's the lowest score that oncologists are even willing to call prostate cancer (it's lower risk than 4+3, which is also Gleason 7).

One likely recommendation is what they call "active surveillance", which means just more-frequent blood tests and scans to keep an eye on it. If PSA hits 10 or so (depending on the oncologist), they might consider trying some medication, but I think it would be less common to jump straight to surgery or radiation with only a 3+4 score.

The other good news is that the long-term survival rate for Gleason 3+4=7 with treatment is somewhere over 99%, I think.

There are probably cancer patients who need treatment urgently being triaged ahead of your husband, so in a sense, it's good news that they're not in a rush to see him, even though the wait is stressful. For me in 2021 it was straight into a hospital bed, being wheeled back and forth on a stretcher for a few days for endless tests and imaging while they tried to figure out what was happening, rushing into the operating room in the wee hours for 10+ hours of emergency surgery, then 3 1/2 months before I was stable enough to be allowed to go back home. Trust me, you don't want to be in a situation where they're eager to take him in a hurry. 🙂

In the meantime, many people in the forum have found this book very helpful for understanding prostate cancer, including your husband's situation. It's well worth a read (even though things have already changed a bit just since it was last updated in 2023.
https://www.amazon.ca/Patrick-Walshs-Surviving-Prostate-Cancer/dp/1538726866

The good news is that Gleason 3+4 is borderline: it's the lowest score that oncologists are even willing to call prostate cancer (it's lower risk than 4+3, which is also Gleason 7).

One likely recommendation is what they call "active surveillance", which means just more-frequent blood tests and scans to keep an eye on it. If PSA hits 10 or so (depending on the oncologist), they might consider trying some medication, but I think it would be less common to jump straight to surgery or radiation with only a 3+4 score.

The other good news is that the long-term survival rate for Gleason 3+4=7 with treatment is somewhere over 99%, I think.

There are probably cancer patients who need treatment urgently being triaged ahead of your husband, so in a sense, it's good news that they're not in a rush to see him, even though the wait is stressful. For me in 2021 it was straight into a hospital bed, being wheeled back and forth on a stretcher for a few days for endless tests and imaging while they tried to figure out what was happening, rushing into the operating room in the wee hours for 10+ hours of emergency surgery, then 3 1/2 months before I was stable enough to be allowed to go back home. Trust me, you don't want to be in a situation where they're eager to take him in a hurry. 🙂

In the meantime, many people in the forum have found this book very helpful for understanding prostate cancer, including your husband's situation. It's well worth a read (even though things have already changed a bit just since it was last updated in 2023.
https://www.amazon.ca/Patrick-Walshs-Surviving-Prostate-Cancer/dp/1538726866

I will look for the studies. There have been a number of them. I have 4+3 with cribiform.
I had SBRT without adt.
Cribiform still isn’t fully understood. We know it is more aggressive but how much more is depends on a number of factors.
-no IDC
- no hypoxia in tumor
- basal immune subtype of tumor
- no PTEN loss
The PTEN and IDC were the biggest factors. PTEN loss amplifier of aggressiveness
I’m not a doctor, but as they say
“no two cancers are alike”.
I was fortunate to have an oncologist dig into my case as an individual.

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.