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Yes, but when you "miss the window" TWICE due to doctor's nonchalance, there is no warranty that it will not happen the third time ? We insisted from the beginning on "vigilant" approach and were dismissed. Even now we are dismissed - tried to make app with oncologist and were not able to !
No matter if the study is old or new- IDC is IDC and cribriform is cribriform and always a bad prognostic factor across all stages, period. No vigilance is going to make it less. The only time that some change in progression of disease can be made is very early intervention before cells become cribriform and/or IDC and if RP is expertly performed with negative margins while PC is fully contained in a gland and with small tumor burden.
Knowing what I know now about IDC and cribriform, I think that it is unconscionable to tell a patient with those pathology features to "take their time" and "think about a treatment".
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Unfortunately, I think a lot of cribriform/IDC may just be missed at many biopsies.
That said, my personal feeling is that PCa should be hit early - and hard.
If I could turn back the clock I would have done adjuvant radiation with ADT after surgery. My prostate was brimming with cancer and had I known that there was a ‘tiny break’ in the capsule I would have insisted on more treatment.
But my surgeon was a ‘superstar’ in the prostate world and he wanted the ‘W’ all for himself.
I think many surgeons see adjunctive treatment as a failure somehow. This is why multiple opinions across different areas of treatment - surgical, radiological, medical - are so important. They give YOU all the different ways of looking at your treatment and allow you to make a well informed decision.
Phil