Cribriform cells: Does their presence change treatment approach?

Hi, based on the research I have done for my prostate cancer diagnosis, I think your Urologist is giving you good advice. With a Gleason score of 3+4 and cancer that is contained to the prostate, active surveillance could be one of the options available. I don't say this to suggest this treatment option, but rather to indicate that from the information you have provided, his form of cancer is not aggressive and not likely to progress significantly in six months or likely even longer.

I am also from Canada (central Alberta). Before having a biopsy, I had a PSMA MRI, which detected a small lesion that extended outside the capsule of the prostate. A subsequent biopsy confirmed that the lesion was cancerous (Gleason 4+3) with Cribriform Pattern 4 present. I had a subsequent PSMA PET Scan that showed no indication of spread. Because my cancer had more aggressive indicators than your husbands (i.e., it extended outside of my prostate capsule, was Gleason 4+3 and had Cribriform pattern), I definitely required treatment and had a robot assisted radical prostatectomy on July 14th. My follow-up pathology showed no cancer in any of the margins of what was removed or in removed lymph nodes and seminal vesicles. This was good news and post surgery pathology is standard testing that they will do if your husband opts for surgery.

A few things to consider:
1) Check if the biopsy results mention anything about Cribriform Pattern, which is a more aggressive form. If it was not found this is a good sign.
2) If your husband had a PSMA MRI test before getting a biopsy, this provides an image of prostate and whether the cancer is confined to the prostate or may have spread to surrounding tissues. I was not sure what you meant by "Contained in both side prostate", but if you meant that the cancer is confined to the prostate this is also a good thing.
3) I did a lot of online research from reputable sites and spoke to two different urologists, but I still wasn't sure I knew enough about the treatment options to be sure that a prostatectomy was the best option for me. I decided to book private consults with a urology surgeon and a radiation oncologist at the Mayo Clinic. It cost me a few thousand dollars US, but I was able to get all of my questions answered within a couple of weeks and I am very happy I did it.
4) If your husband decides on a prostatectomy, make sure he gets a robot assisted radical prostatectomy or RARP and not an Open prostatectomy. While research may indicate that the outcomes may be similar, the recovery is much faster RARP.
5) I suggest at least checking into active surveillance as a treatment option, if only to give you comfort that your husbands cancer, based on what you posted and my understanding as a fellow patient only, is likely to progress slowly.

I empathize with you because I found the uncertainty on not being sure what to do and then not being sure when it will be done to be the hardest part.

I wish you and your husband all of the best.

I have read about this and this part was quite informative

SBRT is an excellent option for most localized prostate cancers, but for tumors with a cribriform pattern, the risk of recurrence is higher and SBRT may not fully eliminate the cancer. These cases often require more aggressive or combined treatment approaches, and decisions should be made in consultation with a specialist. As a result surgery is recommended for localized cancer.
EBRT is also recommended with a little bit higher dosage than without cribriform.

Hi, based on the research I have done for my prostate cancer diagnosis, I think your Urologist is giving you good advice. With a Gleason score of 3+4 and cancer that is contained to the prostate, active surveillance could be one of the options available. I don't say this to suggest this treatment option, but rather to indicate that from the information you have provided, his form of cancer is not aggressive and not likely to progress significantly in six months or likely even longer.

I am also from Canada (central Alberta). Before having a biopsy, I had a PSMA MRI, which detected a small lesion that extended outside the capsule of the prostate. A subsequent biopsy confirmed that the lesion was cancerous (Gleason 4+3) with Cribriform Pattern 4 present. I had a subsequent PSMA PET Scan that showed no indication of spread. Because my cancer had more aggressive indicators than your husbands (i.e., it extended outside of my prostate capsule, was Gleason 4+3 and had Cribriform pattern), I definitely required treatment and had a robot assisted radical prostatectomy on July 14th. My follow-up pathology showed no cancer in any of the margins of what was removed or in removed lymph nodes and seminal vesicles. This was good news and post surgery pathology is standard testing that they will do if your husband opts for surgery.

A few things to consider:
1) Check if the biopsy results mention anything about Cribriform Pattern, which is a more aggressive form. If it was not found this is a good sign.
2) If your husband had a PSMA MRI test before getting a biopsy, this provides an image of prostate and whether the cancer is confined to the prostate or may have spread to surrounding tissues. I was not sure what you meant by "Contained in both side prostate", but if you meant that the cancer is confined to the prostate this is also a good thing.
3) I did a lot of online research from reputable sites and spoke to two different urologists, but I still wasn't sure I knew enough about the treatment options to be sure that a prostatectomy was the best option for me. I decided to book private consults with a urology surgeon and a radiation oncologist at the Mayo Clinic. It cost me a few thousand dollars US, but I was able to get all of my questions answered within a couple of weeks and I am very happy I did it.
4) If your husband decides on a prostatectomy, make sure he gets a robot assisted radical prostatectomy or RARP and not an Open prostatectomy. While research may indicate that the outcomes may be similar, the recovery is much faster RARP.
5) I suggest at least checking into active surveillance as a treatment option, if only to give you comfort that your husbands cancer, based on what you posted and my understanding as a fellow patient only, is likely to progress slowly.

I empathize with you because I found the uncertainty on not being sure what to do and then not being sure when it will be done to be the hardest part.

I wish you and your husband all of the best.

This was a small but interesting study. The only one I could find that compared cribiform with and without IDC.
https://pubmed.ncbi.nlm.nih.gov/31059665/
The study was too small to be definitive, but hopefully it leads to more studies.
My MO at the University of Cincinnati was the one who got me interested in it. She said when she sees cribiform she looks for 2 things;
- accompanying IDC or
-PTEN loss (on Decipher)
If either are present she treats it much more aggressively.
Obviously she didn't dismiss the need for treatment with cribiform. But she said alone it raises a yellow flag. In conjunction with IDC or PTEN loss, it's a red flag.

It's interesting that historically, IDC (much more aggressive) was lumped with cribiform and it wasn't until 2016 that the WHO recognized them as 2 distinct findings.

It was confusing to me when diagnosed because Dr. Google told me it was basically a death sentence but the none of the doctors I consulted with felt it would change there approach to therapy. The one thing it certainly did was rule out active survellience.

Thank you for replying in detail! My husband 68 years old, non diabetic and non hyper tensive, non smoker, has acinar adenocarcinoma stage II. On both sides of prostate but within the prostate. 3 out of 15 cores positive. first core 10% 3, second 15% 3 and the third one 25% consisting of 19% 3 and 6% 4. No cribiform. PSMA pet can and MRI clear except for the prostate. I think there were 3 areas on the prostate, 2 of them less than 5mm and 1 was 10 mm. biopsy done 30th april. surgery may be in Oct. Just wondering if the wait is too long. Surgeon is very experienced wth good ratings. refuses to precribe ADT while waiting 6 months. Can you tell me how long you waited from date of bipsy for surgery and if you were prescribed any medication during the wait? Thank you.

You need to find a more supportive doctor. Your doctor does not appear to be aware of how six months could be a major factor in someone’s cancer growth if they are not on ADT. Yes, it grows slowly, but not even considering putting him on ADT is a problem.

Did you ever speak to A radiation oncologist, about radiation instead of surgery or even one of the other treatments that work quite well with somebody that has cancer a your husband‘s level. Here are Non radiation treatments your husband could consider HIFU , Cryoabalation , NanoKnife , TULSA PRO, HoLEP.

It sounds like you found a urologist who really isn’t experienced enough for modern treatments. You would be much better off, going to the Mayo Clinic or finding a Genito urinary oncologist, They are the ones that specialize in prostate cancer.

There is no reason your husband should wait six months for treatment.

Thank you so much for your comments. I agree with you that 6 months seems long for going without medication. We have decided on surgery but if we change the doctor we may have to wait longer. Also. the surgeon we have been allocated has a great reputation. Only problem is going without medication in the meantime.

Thank you for replying in detail! My husband 68 years old, non diabetic and non hyper tensive, non smoker, has acinar adenocarcinoma stage II. On both sides of prostate but within the prostate. 3 out of 15 cores positive. first core 10% 3, second 15% 3 and the third one 25% consisting of 19% 3 and 6% 4. No cribiform. PSMA pet can and MRI clear except for the prostate. I think there were 3 areas on the prostate, 2 of them less than 5mm and 1 was 10 mm. biopsy done 30th april. surgery may be in Oct. Just wondering if the wait is too long. Surgeon is very experienced wth good ratings. refuses to precribe ADT while waiting 6 months. Can you tell me how long you waited from date of bipsy for surgery and if you were prescribed any medication during the wait? Thank you.