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Cribiform pattern

Posted by stldadof4 @stldadof4, 6 days ago

Hi everyone. It’s been a couple of months since I last posted. I wanted to provide an update and see if anyone has experienced something similar. I am 58 and was initially diagnosed Gleason 7, favorable intermediate (one 3+4 and two 3+3 cores, all on the left side, no cribiform, EPE, etc.) following a transrectal biopsy in early December. That was at a large, reputable urology practice here in St. Louis. They were recommending surgery, but I wanted to try Active Surveillance for at least 6 months, use that time to research my options, and then reassess — which they agreed with. In that time, my intent was to especially look into focal therapy, should I need anything at all — and hopefully stay on AS for as long as I can.

Based on recommendations here and from others, I decided to transfer my care to Siteman Cancer Center (Washington University), which is a Center of Excellence located here in town. When I moved there, we decided to re-biopsy in March, but do transperineal this time. The results ended up being a bit worse (three 3+3s, and two 3+4s — all with higher percentages, mostly on the left again, but one of the 3s was on the right side). The kicker is that this one also showed cribiform pattern in one core.

According to the Wash U doc, I am no longer a candidate for AS, and with these new results (particularly the cribiform) he would tend to move me from favorable to unfavorable intermediate. I am thinking it’s possible that nothing actually changed inside me, but instead they were able to sample more of the prostate this time due to the biopsy being TP vs. TR. The doc agreed with that possibility.

They are sending samples for Decipher testing. I’m scheduled for a PET Scan on Friday, and a radiology consult next week. I am also part of a program through work that facilitates second opinions and consults for employees who are dealing with cancer. I will be going to Cleveland Clinic for that on 4/24. As part of that, they will peer review my test results beforehand and presumably conduct their own pathology review.

St. Louis University Hospital (not a COE) conducts TULSA, so I figured I would meet with them too. My doc does not believe I am a candidate for focal therapy now that cancer has been found on both sides, but is supportive of me meeting with SLUH to learn about TULSA before I decide on anything.

A few questions for the group:

1) have others experienced a significant difference in findings based on the type of biopsy (TR vs. TP)?

2) For those who underwent focal therapy (TULSA or other methods), did you have any cribiform pattern and/or presence of cancer on both sides?

3) Has anyone’s initial biopsy results showed cribiform, but then you got a second opinion on those slides which disagreed with that finding and said no cribiform?

Thanks for reading and offering your input. If you have any other questions or suggestions, please let me know.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | 6 days ago

The fact is prostate cancer gets worse over time. People go from 3+3 to 3+4 or 4+3 over a period of years because their cancer intensifies. My brother was on active surveillance for six years his biopsy three years ago showed he had two 4+3 and two 3+4. People on active surveillance have their cancer become more aggressive over time. I know people that have had it 4+5 after being on active surveillance for a while.

While doing the Transperineal Biopsy can get to more areas of the prostate. It is very likely that the Cancer Just spread more and got more aggressive (Cribriform), though it is possible, they missed it the first time.

There are people in this forum that have had low Gleason scores, Thought they were capable of going on active surveillance, but decided on surgery and found out they had a Gleason nine.

One question is, was it large cribriform? That’s over .25 mm. That’s the real aggressive cribriform.

After six years and a few different biopsies, my brother‘s latest one did show Cribriform. He had SBRT radiation and has been doing fine for the three years since. His was specifically listed as small cribriform.

You could have a second opinion done on your biopsy. There are a couple of doctors that will do it for you. It’s about $500.. Dr. Epstein will talk to you for quite a long time about what’s found and tell you his thoughts about what it means.

Dr. Epstein biopsy
https://advanceduropathology.com
Dr. Zhou
S
Send an email to Ming.zhou@mountsinai.org to inquire about a second opinion and ask for his specific instructions for the process.

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Profile picture for stldadof4
stldadof4 | @stldadof4 | 6 days ago
In reply to @jeffmarc "The fact is prostate cancer gets worse over time. People go from 3+3 to 3+4 or..." + (show)
Profile picture for Jeff Marchi @jeffmarc

The fact is prostate cancer gets worse over time. People go from 3+3 to 3+4 or 4+3 over a period of years because their cancer intensifies. My brother was on active surveillance for six years his biopsy three years ago showed he had two 4+3 and two 3+4. People on active surveillance have their cancer become more aggressive over time. I know people that have had it 4+5 after being on active surveillance for a while.

While doing the Transperineal Biopsy can get to more areas of the prostate. It is very likely that the Cancer Just spread more and got more aggressive (Cribriform), though it is possible, they missed it the first time.

There are people in this forum that have had low Gleason scores, Thought they were capable of going on active surveillance, but decided on surgery and found out they had a Gleason nine.

One question is, was it large cribriform? That’s over .25 mm. That’s the real aggressive cribriform.

After six years and a few different biopsies, my brother‘s latest one did show Cribriform. He had SBRT radiation and has been doing fine for the three years since. His was specifically listed as small cribriform.

You could have a second opinion done on your biopsy. There are a couple of doctors that will do it for you. It’s about $500.. Dr. Epstein will talk to you for quite a long time about what’s found and tell you his thoughts about what it means.

Dr. Epstein biopsy
https://advanceduropathology.com
Dr. Zhou
S
Send an email to Ming.zhou@mountsinai.org to inquire about a second opinion and ask for his specific instructions for the process.

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@jeffmarc Thanks so much for the insight and suggestions. The pathology report doesn’t say anything about the size of the cribiform. It simply says “cribiform pattern observed” next to one of the 3+4 cores. I’ll be sure to ask.

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Profile picture for surftohealth88
surftohealth88 | @surftohealth88 | 5 days ago
In reply to @stldadof4 "@jeffmarc Thanks so much for the insight and suggestions. The pathology report doesn’t say anything about..." + (show)
Profile picture for stldadof4 @stldadof4

@jeffmarc Thanks so much for the insight and suggestions. The pathology report doesn’t say anything about the size of the cribiform. It simply says “cribiform pattern observed” next to one of the 3+4 cores. I’ll be sure to ask.

Jump to this post

@stldadof4
I agree with all that Jeff said, just wanted to add that as far as I know Cleveland Clinic is THE TOP place to ask about size and classification of cribriform since they were among the first ones who actually did extensive research in that field and they found out that size bigger than 0.25 mm is "large" and dangerous one.

So, if you are going to have your pathology reexamined in Cl. Clinic, that is a really good thing : ) and great opportunity.

Wishing you the best of luck with it all .

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jeff1963 | @jeff1963 | 5 days ago

This is not what you asked for, but my biopsy results changed from 3+4 to 3+3 on a second reading. Both readings happened at different COEs. Just saying things can change, even at a COE.

Don't think you can do any better than Cleveland Clinic, but Vanderbilt is closer to St Louis, Vandy is also a COE and where I got my second opinion. Dr Chang at Vandy is top notch.

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Profile picture for stldadof4
stldadof4 | @stldadof4 | 5 days ago
In reply to @surftohealth88 "@stldadof4 I agree with all that Jeff said, just wanted to add that as far as..." + (show)
Profile picture for surftohealth88 @surftohealth88

@stldadof4
I agree with all that Jeff said, just wanted to add that as far as I know Cleveland Clinic is THE TOP place to ask about size and classification of cribriform since they were among the first ones who actually did extensive research in that field and they found out that size bigger than 0.25 mm is "large" and dangerous one.

So, if you are going to have your pathology reexamined in Cl. Clinic, that is a really good thing : ) and great opportunity.

Wishing you the best of luck with it all .

Jump to this post

@surftohealth88 thanks so much for the comment. Makes me feel better knowing this.

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Profile picture for stldadof4
stldadof4 | @stldadof4 | 5 days ago
In reply to @jeff1963 "This is not what you asked for, but my biopsy results changed from 3+4 to 3+3..." + (show)
Profile picture for jeff1963 @jeff1963

This is not what you asked for, but my biopsy results changed from 3+4 to 3+3 on a second reading. Both readings happened at different COEs. Just saying things can change, even at a COE.

Don't think you can do any better than Cleveland Clinic, but Vanderbilt is closer to St Louis, Vandy is also a COE and where I got my second opinion. Dr Chang at Vandy is top notch.

Jump to this post

@jeff1963 it is confusing to get such different readings, but I suppose it’s just how one expert reviews vs another. I didn’t consider Vandy. Nashville isn’t far. I’ll look into that too. The Cleveland consult (including travel) is covered by my employer. Siteman (here in STL) is also COE. It’s great that we have so many resources.

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Profile picture for jcf58
jcf58 | @jcf58 | 5 days ago

I was 4+3 with cribriform and did Tulsa at Mayo July 2024. I only had one lesion. PSA has remained steady and no sign of cancer at this point.

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