"Cribriform" as part of Pathology Report

Based on what you shared in the other thread, you are 6 years post-prostatectomy and just now seeing a slight uptick in your PSA, to 0.02. Is that correct?

If that's the case, the cribriform pattern likely does not change anything for you in the short term. The most important thing is to continue to test your PSA regularly using the same ultrasensitive assay at the same lab. Velocity of increase is going to be the most important consideration for when to potentially start salvage radiotherapy, but the prior presence of large cribriform may nudge you to a slightly earlier start for SRT, all other things being equal.

There are still no RCTs (nor even any retrospective studies I'm aware of) that show any benefit to initiating SRT prior to a PSA of 0.1 in cases like yours. But starting between 0.1 and 0.2 may confer some OS advantages relative to waiting until 0.2 or higher. Did you have a genomic risk assessment on your post-op tissue, like Decipher?

All of these topics are things to discuss with your care team, of course. Best of luck.

@notpetecrowarmstrong
Appreciate your response. Decipher was .62. Am seeking a second opinion on the situation and they ordered an independent pathology review. They made a comment about the Cribriform, stating it was the 'high risk issue' of the report. Guess if these cells have awakened, it can be an issue. They can multiply and spread quickly. They have a few reports recently (i.e. ProtecT) that dictate the ability for it to metastasize and increase the rate of mortality. Also, mention the T3b as a criteria. This is relatively new and could make it easier for those who DO NOT have the Cribreform to perhaps delay treatment (as I interpret it). No MD, but this appears to be a breakthrough that could help some avoid radical treatments, and for someone like myself to hurry the aggressive treatments. Again, no MD however do a lot of research and ask many questions. Fnding out for the first time, this can be a 'red flag'.

Here is the link to a talk where they discussed large cribriform. It does make your cancer much more aggressive. More recent studies have shown that radiation is probably the best though in the past surgery was recommended and even today many doctors are still saying they want to do surgery.

Your Gleason score and other measurements like your PSA Diagnosis can be important.

I know one person with large cribriorm who has had a decipher test and an ArteraAI Test both of which came in very low. He only has a 3+4 Gleason. He’s held off doing any treatment for a year so far after talking to multiple doctors who have agreed with him that he probably could wait. This isn’t an unusual situation, but it happens.
https://www.urotoday.com/video-lectures/a-journal-club-for-patients-with-prostate-cancer/video/mediaitem/4452-unfavorable-histology-classification-aims-to-reduce-unnecessary-treatment-journal-club-jesse-mckenney-cornelia-ding.html