Very interesting pathology report about cribiform

That could be. It had a small lesion and cribiform was only noted in 1 of 5 cores. (5/15), 3 takes from lesion.

@bearcat998

Since your Decipher is so low ( that is great indicator !!! : ) ), I am sure that your cribriform are small and do not have those awful mutations that cause mets .
My husband's Decipher was 1 - the highest that exist and that was ever here reported :(. So, yes, you probably do not have much higher risk than regular 4+3 gleason. : ))) You caught it in time before those small cells became bigger. *high five : ))

There is significant difference between small and big cribriform aggressiveness and those are all very new discoveries. If you watch the link that Jeff posted in this thread (where pathologists discuss new classifications and methods - it is presented in plain language, everybody can 100% understand it ), you will see that even new pathologists in top hospitals are going through "extra training" to learn all about that .

You mention "biopsy" but not post-prostatectomy "surgical pathology report." As an FYI - it is impossible to view Cribriform glands on a cytological "biopsied" sample. Cribriform glands require a small "sheet" of prostate tissue on the slide, not the cells punched from the biopsy. That is the fallacy of the biopsy and Gleason Score: they tell you nothing of whether you have Extraprostatic Extension (EPE), Surgical Margins, Seminal Vesicle invasion (one or both), etc. That are only discerned with the entire, removed prostate when the Histology Techs slice and dice "all" of the diseased, cancerous sections of your surgically removed prostate. Those are small "sheets" of tissues sectioned by a microtome cutting through a paraffin block that is holding the prostate tissue. Again, the "biopsy" is like any "punch biopsy"...the cells/tissue extracted are expelled into a jar of formalin. That jar of formalin is handled such that the contents are put into a cytocentrifuge that holds several samples and several microscope slides. The centrifugal force deposits the "cells" onto the microscope slide which is then stained and examined microscopically. There are no "sheets" or larger pieces of tissue like when the Histology Techs and Pathologist exams pieces/"sheets" of tissue. Your physician should have been more straight forward telling you that Cribriform gland tissue cannot be discerned with biopsied cellular material. Hope this helps.

Regarding that Chief Pathologist’s comment that "…..the presence of cribriform pattern is documented in all cancers that have pattern 4 but not always stated on report"

I did a quick literature search on this (and stopped after the very first one). In this 2024 paper (https://pmc.ncbi.nlm.nih.gov/articles/PMC10935882/) they investigated 108 patients with Gleason 8(4+4) prostate cancer who underwent RARP, and found that 62.0% of the patients had a cribriform pattern in RARP specimens.

So, though it may be said that Cribriform pattern is highly correlated with “pattern 4,” it cannot be said that “cribriform pattern is documented in all cancers that have pattern 4.”

@rlpostrp That was a great explanation of the differences between the two biopsies; and it makes sense that a ‘slice’ through an intact gland/tumor would really show the actual ‘map’ of the arrangement of cells, rather than a jumbled mass of cells spun down and plastered on a slide.
Cribriform pattern would be especially sensitive to this technique, since it’s the ‘swiss cheese’ appearance which the pathologist is looking for; an arrangement of cells, not just cells themselves…..
wouldn’t that pattern be destroyed in a centrifuge?
So I have to ask, how are all these cribriform patterns being found on these punch biopsies??
Are they shredded remnants? Are the ‘patterns’ simply being caused by the slide preparation itself?
I think it’s very important because we say all the time: “oh, you have cribriform so radiation might not work”…
Sounds pretty darn
Vital to the whole treatment plan scenario! Thanks,
Phil

@rlpostrp
I know many people who had cribriform Found from a biopsy. My brother only had a biopsy and had SBRT radiation for treatment. His biopsy report specifically mentions he has a small cribriform.

Some of the other things can be found through biopsy as well. My doctor thought I might have seminal Vesicle invasion based on the MRI. He did another biopsy to find out whether that was true. It was not, and the prostatectomy confirmed it.

@jeffmarc

Of course they can be seen on a biopsy *sigh

Sometimes they are "missed" if probe goes under certain angle or measurement is than wrong (small versus large)

My husband's biopsy samples and slides contained cribriform AND his post op slides contained cribriform.

I wish people actually find time and look at slides that are available online and watch presentations with biopsy slides and perhaps than they will understand everything better.

https://onlinelibrary.wiley.com/doi/10.1111/his.15102
Here is a link with CLEAR view of BIOPSY sample and CRIBRIFORM gland in FULL view

@jeffmarc Great 28 min. video! Now I see the risks of the cribriform pattern, >/25 cm, and chance of metatasis.

@bearcat998 Good to hear someone else consulted with top doctors that didn't even bring it up. Like I mentioned in my OP I'm fortunate enough to have consulted with 2 of the top 15 COE's in the US and neither the urologist or the RO's ever mentioned it from biopsy report. This was what made me believe the chief pathologist's comment about all 4's present with "some type" of cribriform pattern.
I also did not have IDC, clear PSMA & MRI. Like you I read about cribiform on google and also thought it was a death sentence. Don't get me wrong it's definitely a negative factor to consider along with other test results.