Cribriform cells: Does their presence change treatment approach?

I really believe that your surgeon is giving you good advice. My surgery was originally scheduled to be six months from my biopsy, like your husband's. I consulted widely before my surgery. I spoke to two Urologists here in Alberta, and I travelled to the Mayo Clinic in Florida to have private consults with another Urologist and a Radiation Oncologist. All agreed that surgery was the best option for me and that waiting six months should not be a concern. And remember, my cancer was significantly more aggressive than your husband's. My cancer had extended outside of the capsule of my prostate, it had Cribriform and was Gleason 4+3.

I remember, when I asked the Radiation Oncologist what he would do in my circumstance, he said that he would opt of surgery over radiation because of the adverse side effects of ADT that would be part of the radiation therapy.

I also asked him if he would opt to pay for surgery out of pocket to get it early and he had a humorous response, but he meant it. He said: No, I would use the money to go on a long cruise and would wait for surgery in six months without worrying about it.

In summary, from the information you provided your husbands cancer does not have aggressive characteristics and from my research and consults, I do not think waiting six months for surgery is too long. In your husbands circumstance, I would not consider taking ADT before surgery. The side effects of ADT are supposed to be very unpleasant.

Finally, make sure your husband is getting the Robot Assisted Radical Prostatectomy or RARP surgery.

Thank you so much for your comments. I agree with you that 6 months seems long for going without medication. We have decided on surgery but if we change the doctor we may have to wait longer. Also. the surgeon we have been allocated has a great reputation. Only problem is going without medication in the meantime.

At that UCSF conference I went to the size of cribriform was a real critical issue. If over 2.5 mm it meant that the Gleason score had a 5 in it even if it was a 3+4

The doctors also mentioned that if somebody has intraductal they almost certainly have Cribriform. Tying the two together more than what do you seem to have heard?

Sure would be helpful if they could do a study that center on people that had cribriform, to see the long-term impact.

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.

I must admit, Considering the case, you have six months is not excessive To wait for surgery. I did Errr saying it was a mistake to wait that long.. If I had been a Gleason nine with it already spreading outside the prostate that would be different.

As others have said, however, I still think it would make a lot of sense to get a second opinion.

so did you wait 6 months or opt for earlier paid surgery?

I did not opt for earlier paid surgery; however, Alberta Health Services, who control the availability of surgical beds, unexpectedly opened up additional surgical times this summer, so was able to get my surgery a couple months earlier than expected on July 14th. My surgery went really well; 'it could not have gone better' according to the surgeon. Pathology came back with no cancer on the margins of what they removed. So far, I have have had the best possible outcomes with my surgery. I get my catheter out tomorrow after two weeks, which I am really looking forward to.

At the risk of repeating myself, your husband's cancer does not have the aggressive characteristics that mine had, and all the advice I received was that I should not worry about waiting six months. That said, everyone should make their own decision and I do remember having some anxiety until I settled on a treatment plan that I felt was right for me.

I wish you and your husband all the best.

FYI, here is some information help you and your husband know what to expect. During my surgery, they took extra tissue from around my lesion and also removed the nerves on the lesion side, some pelvic lymph nodes. The idea was to spare tissue where they could, but take more tissue where needed to try to remove all of the cancer. They did full pathology on all tissues removed and reported were cancer was absent and where it was found. In my case, cancer was restricted to the one lesion found in my PSMA MRI and, as I noted above, all margins were clear.

My time from diagnosis to treatment was 6 months. I'm not sure that is unusual. There were PMSA scans, genetic and Drcipher tests. Multiple consults. I don't think that is unusual. But if you have already decided on treatment 6 months does seem a long time.