Cribriform present: What does this biopsy finding mean?

Pamperme, I know this comes very late, but I'm choosing treatment and I thank you for your message. I too am 3+4 and have cribriform morphology.
Thanks again, and I hope your healing is going well.
Jim

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675397/ (Recent article! Title: Current Conundrums with Cribriform Prostate Cancer, Author: Gordetsky et al)
A few observations from this article:
1. Reporting cribriform only recently became part of the standard of care.
2. The simple presence or absence may not be clinically significant.
3. It can be associated with genetic risk for prostate cancer.

My husband's pathology also said cribriform present. When I Googled it, it was a bit alarming. The medical and surgical teams told us it indicated his cancer could be more aggressive. What we gleaned from it was that we should move on a decision. He had robotic assisted prostatectomy in June, Mayo Rochester. All cancer gone, clean margins, and he's doing great. Good luck to you and your husband.

Hi Jim
My PSA test for one year are still < .02 showing no cancer. When I had the prosectomy I had two locations where margins were not obtained. I have significant pain which may be pudendal neuralgia. I am going for a pudendal nerve block on January 4. I had pain in the perinium area prior to surgery and some penis pain. The surgery got rid of the perinium pain but now I have pain in the rectal area stopping me from sitting and very bad penal pain. I wish you the best. Timmy

I had the same noted on my pathology report after my RALP in Aug 22. My surgeon/urologist who also heads up Research at his practice has never suggested any further treatment. My report also said no Intraductal cancer. He said my chance of BCR is 30 percent at 10 years. This agrees with the MSK calculators I have seen online which from what I can tell do not take Cribriform into account.
My Gleason was 4 + 3. So far my PSA has been less than 0.1. Hoping and praying it stays that way. I did ask to have my PSA checked every 4 months instead of 6.

Glad to find a conversation on cribriform. My husband is Gleason 3+4. Had a large cribriform morphology in part of one biopsy sample (40%); only two samples of 16 in biopsy show cancer; the rest are benign, He's leaning toward HDR brachytherapy (internal radiation) for treatment, possibly along with 4 months of HDT. The thing most concerning about choosing radiation is that PSA will remain in his system post-treatment. The PSA nadir may be 1 year post treatment. I worry that metastasis might happen, without the ability to catch it because PSA is difficult to interpret since it doesn't fall immediately and may "bounce." . If the prostate is removed, monitoring post-surgry PSA is more black and white. It should be "undetectable"/very low within 3 months of surgery. Not as easy to tell what's going on post-radiation. But he would really like to avoid the side effects short-term, and the possibly long-term, of surgery. Are there any cribriform people out there who chose radiation treatment? I would appeciate hearing of your experiences. And from everyone, which treatment did you choose, and why? I'm worried about his diagnosis! I'm grateful to all the poeple who share on this forum and look forward to any feedback you might have to share. Best wishes to you all!

I have Gleason Score 8 with cribriform. It appears that cribriform is much more common with Gleason 4 and obviously more so with Gleason 4 + 4. There are an incredible number of retrospective studies (where they analyze prostates removed after surgery to identify Gleason Score and cribriform as well as other biomarkers and then use high level statistical or regression analysis to predict biochemical recurrence, metastasis, and cancer specific mortality within 5, 10 and 15 years). Problem is almost all sample sizes are small, obtaining strong consensus agreement on one sample from multiple pathologists that definitively identifies cribriform and intraductal cancer from the same biopsy is hard to come by. Also, some are trying to make the distinction that small cribriform isn't so bad but large cribriform is but the criteria to distinguish between what is large and what is small is unsettled. My sense is the pathological community has identified cribriform as the best biomarker for aggressive to very aggressive prostate cancer...even independent of Gleason Score. Main use is for intermediate or Gleason 7. General consensus is that any biopsy that is Gleason 7 with cribriform needs to be taken care of; that is, it should not be eligible for active surveillance. My experience is that both the urologist and radiation oncologists know that cribriform is bad news, but they just got word of it 4 or 5 years ago. And because it is rare enough that they hardly ever see it, and because it just recently was required to be identified on the biopsy reports, they aren't as "alarmed by it" as the pathologists. I think your treatment needs to be very aggressive. Because the chance for recurrence for me was so high within 3 years and two urologists told me because I had so much cancer they weren't sure how much they could save in terms of sexual function and continence, I chose anti-testosterone therapy (also known as anti-depravation therapy or ADT) for two months, external beam radiation daily for 5 weeks and then 18 more months of hormone "therapy". I didn't want to go through, in my case, the near certain trauma of the surgery and then less than 3 years later go for through the trauma of radiation. Surgery plus radiation is supposed to have slightly better outcomes but probably slightly worse side effects. ADT is no fun. I would recommend talking to a medical oncologist to help decide treatment options. Best of luck to you.

In addition to the above treatment I also received one day high dose radiation treatment one month after the external beam radiation treatment ended.