Surgery or Radiation if large cribriform found in biopsy?

@overage
Well, that link discusses grading systems it also Discusses cribriform and They do say during that discussion that radiation does not work fully on cribriform.

Did you listen to the whole thing?

@jeffmarc Jeff, I listened to the video and did not find anything that said radiation was less effective that a prostectomy. The whole discussion was on the results with prostatectomy. In the latter part of the video there was this comment on radiation:

“Dra. Cornelia Ding: I think one comment I will have is that this paper is focusing on radical prostatectomy. But we know a significant portion of prostate cancer patients may opt for different treatments, like chemotherapy or radiation. So they might not have radical prostatectomy. So how to apply this system into patients who only have biopsy for histology evaluation will be a really interesting question, which I know Cleveland Clinic is working on. And we are also trying to validate in our patient cohort too..” This simply implies they and the the Cleveland Clinic are looking at the cases with radiation but do not have any results yet.

If there is a comment on the relative ineffectiveness of radiation as compared to surgery for prostate cancer with Cribriform glands could you provide the location by minute and second in that video.

The twenty eighth minutes it took to listen to the video was not a complete loss for me. I saved some of the graphs that showed that Cribriform with small glands had some very favorable outcomes. I intend to use those in a forthcoming discussion with my oncologist on suspenion of ADT. My biopsy report indicates presence of Cribriform but no large Cribriform glands were observed.
Regards. Overage

@overage
I’m sorry about that. I thought that particular video specifically mentioned radiation was not successful with cribriform.

Unfortunately, I could not find the information. I attend so many of these presentations and I thought that was the one where it was mentioned. It must’ve been another one, but I can’t find it right now.

Here’s some more information which appears that what I’ve heard was dated or doctors differ on their opinions. It’s interesting that this particular forum is mentioned as one of the sites discussing it.

Cribriform morphology (in prostate cancer) is highly aggressive, with a higher risk of metastasis. While some past discussions suggested surgery was better due to early concerns about radiation missing this pattern, recent clinical analyses show radiation combined with hormone therapy is highly effective, significantly reducing the risk of metastasis

.The debate regarding whether surgery or radiation is best for cribriform prostate cancer involves several nuances:

Traditional Perspective: Historically, because cribriform cells are highly aggressive, experts debated whether radiation could completely eliminate them. In many of these cases, surgeons and oncologists favored radical prostatectomy for physical removal.

Modern Radiation Evidence: Recent studies on the management of cribriform-positive cancer indicate that modern radiotherapy—especially when combined with neoadjuvant Androgen Deprivation Therapy (ADT)—is highly impactful, reducing the long-term risk of metastasis by 65%.

Mixed Patient Opinions: On forums like Mayo Clinic Connect and Reddit, opinions on surgery vs. radiation differ, as some patients with cribriform morphology are advised to use combination radiation and ADT while others are guided toward surgical removal.

The whole cribriform issue is quite confusing. My 20 core biopsy showed 2 small (~.75 cm total) 3+3 spots. The concern was a note "Sections of parts C and F both show atypical intraductal cribriform proliferations (AIP), confirmed by retention of basal cell marker expression (p63 and CK903), by PIN4 cocktail immunohistochemistry performed outside and reviewed here. The
findings raise concern for intraductal carcinoma of the prostate, though are below the threshold for definitive diagnosis. "

Both my Dr's are recommending Active Surveillance regardless. PSMA showed no spread, with an SUV of 10.6. Decipher - .24 (low risk)

All this talk of large and small cribriform still makes me quite uneasy!
Thanks for anyone offering any clarification on the subject.

The whole cribriform issue is quite confusing. My 20 core biopsy showed 2 small (~.75 cm total) 3+3 spots. The concern was a note "Sections of parts C and F both show atypical intraductal cribriform proliferations (AIP), confirmed by retention of basal cell marker expression (p63 and CK903), by PIN4 cocktail immunohistochemistry performed outside and reviewed here. The
findings raise concern for intraductal carcinoma of the prostate, though are below the threshold for definitive diagnosis. "

Both my Dr's are recommending Active Surveillance regardless. PSMA showed no spread, with an SUV of 10.6. Decipher - .24 (low risk)

All this talk of large and small cribriform still makes me quite uneasy!
Thanks for anyone offering any clarification on the subject.

@dacaesar

We learned about cribriform and IDC the hard way, so I will try to be restrained here with my usually panic-inducing posts.

My concern is IDC (intra ductal proliferation) If you just had cribriform and the "small kind", with that low Decipher SA would be reasonable choice. It is still a good choice IF you repeat biopsy every single year - do NOT trust cribriform and IDC to stay "low Decipher" forever. Actually they can progress to very aggressive cancer in no time. Since your results are inconclusive - how about you send your samples to be examined by another lab and get a second opinion ?

I will just say that if we knew what we know today about PC in general, gland would be taken out much sooner and my husband would have had biopsy done every year. We however had very incompetent urologist and my husband had one biopsy that showed 3+3 and than another in 5 years which than showed 4+3 unfavorable which again proved to actually be 4+5 after prostatectomy : ((((.

Wishing you all the best and please, please stay on top of your PC care. MRI every year and biopsy every 1.5 to 2 years 🙏.

@dacaesar

We learned about cribriform and IDC the hard way, so I will try to be restrained here with my usually panic-inducing posts.

My concern is IDC (intra ductal proliferation) If you just had cribriform and the "small kind", with that low Decipher SA would be reasonable choice. It is still a good choice IF you repeat biopsy every single year - do NOT trust cribriform and IDC to stay "low Decipher" forever. Actually they can progress to very aggressive cancer in no time. Since your results are inconclusive - how about you send your samples to be examined by another lab and get a second opinion ?

I will just say that if we knew what we know today about PC in general, gland would be taken out much sooner and my husband would have had biopsy done every year. We however had very incompetent urologist and my husband had one biopsy that showed 3+3 and than another in 5 years which than showed 4+3 unfavorable which again proved to actually be 4+5 after prostatectomy : ((((.

Wishing you all the best and please, please stay on top of your PC care. MRI every year and biopsy every 1.5 to 2 years 🙏.

@overage
I’m sorry about that. I thought that particular video specifically mentioned radiation was not successful with cribriform.

Unfortunately, I could not find the information. I attend so many of these presentations and I thought that was the one where it was mentioned. It must’ve been another one, but I can’t find it right now.

Here’s some more information which appears that what I’ve heard was dated or doctors differ on their opinions. It’s interesting that this particular forum is mentioned as one of the sites discussing it.

Cribriform morphology (in prostate cancer) is highly aggressive, with a higher risk of metastasis. While some past discussions suggested surgery was better due to early concerns about radiation missing this pattern, recent clinical analyses show radiation combined with hormone therapy is highly effective, significantly reducing the risk of metastasis

.The debate regarding whether surgery or radiation is best for cribriform prostate cancer involves several nuances:

Traditional Perspective: Historically, because cribriform cells are highly aggressive, experts debated whether radiation could completely eliminate them. In many of these cases, surgeons and oncologists favored radical prostatectomy for physical removal.

Modern Radiation Evidence: Recent studies on the management of cribriform-positive cancer indicate that modern radiotherapy—especially when combined with neoadjuvant Androgen Deprivation Therapy (ADT)—is highly impactful, reducing the long-term risk of metastasis by 65%.

Mixed Patient Opinions: On forums like Mayo Clinic Connect and Reddit, opinions on surgery vs. radiation differ, as some patients with cribriform morphology are advised to use combination radiation and ADT while others are guided toward surgical removal.