Cribriform cells: Does their presence change treatment approach?

Thank you very much. (Un)fortunately I am located in Canada, hence left to the whims of local administratia. They seem to take their sweet ol’ time. PSA score was 26 the first time around in July, 21 in September and 25 in November. 3+4 Gleason score. 5 cores out of 12 positive. CT scan and Bone scan showed no apparent metastasis. Been told by the urologist that brachytherapy combined with EBRT and short-term anti testosterone therapy is the way to go. Now just endlessly waiting for a PSMA PET scan… it’s taking forever and while we won’t go bankrupt due to medical bills here in Canada, we might well expire before treatment. It’s agonizing.

Excellent.
Finally, finally, have my PSMA PET scan scheduled for December 12. Given that my PSA has remained stable over the past 4 months, and given that no evidence of metastasis was found on a CT as well as a bone scan, I hope that the cribriform damage is limited. Unfortunately, given I had CABG surgery 11 years ago, I was told RALP was too risky for me. So radiation and Brachytherapy, with a side of ADT just to spice things up, is my menu. It feels almost as if my body wants to experience all medical emergencies before expiring. Perhaps a stroke for dessert next...

I'm sorry to hear that. What province are you in? I started treatment quickly (within days of diagnosis) at a Cancer Centre in a large Ontario city, but I know that quality of care can vary from province to province, and even urban/rural within a province.

Definitely try to get into an interdisciplinary Cancer Centre affiliated with a university medical school if you can. Princess Margaret in Toronto is one of the top ranked cancer centres worldwide, but Calgary, Ottawa, etc also have excellent Cancer Centres with world-class treatment.

The urologist at your local hospital might be up on the latest treatment trends in prostate cancer or might be years behind (that applies in both Canada and the U.S.), which is why it's so important to get to a Cancer Centre in Canada or Centre of Excellence in the U.S. if able.

Best of luck.

Located in Waterloo. Three regional cancer center here is affiliated with Princess Margaret. It’s reputation is not world class, but frankly I am not so sure I want to drive 3 hours back and forth every day for a six hour daily commute commitment for what, 18 weeks?

That makes perfect sense. Given the cluster of universities in the area, I'm sure the regional Cancer Centre in KW would also be very good. The main point is that you're under the care of *some* Cancer Centre, rather than just a local practitioner. And I'm glad you have your PSMA PET scan booked now; fingers crossed you'll get good news.

And if for any reason you didn't have a good experience with your local Cancer Centre (Grand River?), there's also the Verspeeten Family Cancer Centre in London, ON as a backup, just an hour's drive away. If it's affiliated with the UWO med school, then it's probably pretty good.

Indeed. I thought perhaps that I should trust the local practitioners and, it is what it is. It makes sense to have confidence that, when the locals were hired to practice their radiation sourcery here, that they hired the correct Druid. At least, I hope so. In the end we all go, the timing is never right.

Radiation has the same overall survival as radical prostatectomy, so don't worry that you're at more risk because you can't have the RALP. If there's been undetected spread just outside the prostate, radiation might catch that as well, while a RALP will not (unless you follow it up with radiation).

Best of luck, and DM me if you'd like to talk more about navigating the care system in Ontario.

Thank you. From previous experience, one needs to learn to “advocate” for oneself in this environment. If I am being considered a nuisance, well, so be it. Appreciate the insight as well as the offer of assistance.

@hanscasteels, I add my belated welcome. I expanded the title of your discussion to include the question you asked. You may also be interested in these related discussions:
- Cribriform present: What does this biopsy finding mean?
https://connect.mayoclinic.org/discussion/cribtiforms/
- Cribriform Pattern 4: What did you learn about this?
https://connect.mayoclinic.org/discussion/cribriform-pattern-4/

It's below 0.1. Never had the ultra sensitive test. One time my PSA was tested at a lab with a low threshold of 0.03. My PSA was listed as < 0.03. At 1 year out from surgery I requested being put on a PSA test schedule of once every 4 months instead of every 6 months. At two years out I requested to be tested twice a year instead of once a year. My Surgeon/Urologist had no issue with this. Sounds to me like your PSA results have been excellent.