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.