Surgery or Radiation if large cribriform found in biopsy?

Fascinating discussion. Thanks to all who participated. Cribiform is being acknowledged as an independent risk factor but there sure doesn't seem to be consensus on what that means. My read to date is that it is a risk not fully captured by the Gleason scale so those of us that have this variant must be vigilant in asking these questions and pressing on whether standard treatment protocols are sufficient. It also occurred to me that I don't know if I have/ had large or small cribiform and I am not sure I need to know since I originally had surgery and now am on ADT after salvage radiation. Best wishes to all. Dave

@wheel1 Thanks - Dr. Sprenkle, my doc was one the first to use it at Yale. He showed me just why on my MRI my anatomy may not be amenable to the surgery. When I met him, I told him if it comes to that - "take it out". I appreciate an honest practitioner. Right now, both Yale and Hartford Health Care (Joseph Wagner, who's done the most RP's in the state of CT) advised that I'm intermediate, favorable risk. I'm still concerned, and that's why I'm here discussing this.

@dhasper
Are you done with RT 😃 ??? If yes CONGRATS ! I hope that you did not have any special irritation of the bladder or rectum 🍀 and are now just counting days till the end of ADT : ))) ! You got only 4 mos of it - right ? You must be really relieved and happy to now embrace all summer fun that is ahead of you : ))) !
Don't forget all of us here ; ) !!! lol

@dacaesar
You have really competent and caring doctors, there is no doubt about it 👍😃 ! You are in good hands and it is a blessing : ))).

Wishing you great results with whatever path you choose 🍀 : ))) !

@surftohealth88 Definitely one of the luckier people in the country with great insurance where I can choose to go wherever to get the best care. And being in RI, near centers of excellence doesn't hurt either!

Thanks!

I'm a little concerned about all this.
I had my RARP about 6 months ago, and will be reviewing my latest PSA reading with my surgeon's PA this afternoon (still negligible, but has risen a bit, which freaks me out some).
My pathology actually downgraded the biopsy findings from Gleason 8 to 3+4, with 4 comprising around a quarter, which is nice, but it also says Cribriform glands are "present" (no reference to size), along with Perineural Invasion.
It also mentions <1mm of unifocal, gleason 3 margin involvement.
So I had been thinking I had done really well given the Gleason reduction, but now I'm a little unsure...

@sandguy
You want to find out if the pathologist that did the analysis of your prostate was a specialist in prostate cancer or was he a specialist and some other type of disease.

This is one thing discussed in the ancan.org Video from the discussion with Dr. Jonathan Epstein who is a specialist in biopsy second opinion. He seen hundreds of thousands of them and can really let you know what’s going on. He does charge $500 however for a review. You contact his office and they arrange to get the tissue and do the testing. He actually can call him ahead of time and discuss it and after he does the analysis you can talk to him for quite a while about exactly what’s going on.

If you don’t feel you got the complete answer yet he can give it to you.

Dr. Epstein biopsy
https://advanceduropathology.com

@jeffmarc
Thank you for that Jeff.
I'm a little unclear on whether he can provide second opinions on tissue pathology, resulting from my RP, as opposed to results from needle biopsies. The biopsy I had a year ago did mention Perineural Invasion, but nothing about Cribriform, although as I said, it actually showed a higher Gleason grade than turned out to be the case after the RP.
Unsure whether a second opinion at this point will affect any future decisions, as I expect that will be more dependent upon PSA than anything, e.g. if it reaches the 0.2 ng/ml level.

@sandguy
You want the second opinion on the tissue after the radical prostatectomy?

There’s a lot more information there than there is in a biopsy that only gets 1% of the prostate.

But don’t take my word for it. Talk to Dr. Epstein and see what he thinks.. We will talk to you there is no problem getting his help before doing the second opinion