Cribriform cells: Does their presence change treatment approach?

Hi everyone, I’m hoping to get some insights or hear from others with similar experiences. I’m currently 8 months into treatment for prostate cancer. My regimen has included:
Firmagon (ADT) since diagnosis (8 months so far)
23 fractions of external beam radiation (EBRT)
1 HDR brachytherapy insertion
Initial PSA was 26.7
Current PSA is 0.47
Testosterone is at castrate levels
Pathology showed cribriform pattern, which I understand can indicate a more aggressive form of cancer
I’ve heard (including from Dr. Mark Scholz) that PSA should ideally be ≤0.1, and preferably closer to 0.01, by this point in therapy. While my drop from 26.7 to 0.47 is substantial, I’m concerned it may not be as low as it should be, especially after combined ADT, EBRT, and HDR. Has anyone experienced a similar slower or plateauing PSA response? Should I be concerned about the possibility of hormone-resistant disease or undertreated cancer?

I would really appreciate any thoughts or experiences you’re willing to share.

I really believe that your surgeon is giving you good advice. My surgery was originally scheduled to be six months from my biopsy, like your husband's. I consulted widely before my surgery. I spoke to two Urologists here in Alberta, and I travelled to the Mayo Clinic in Florida to have private consults with another Urologist and a Radiation Oncologist. All agreed that surgery was the best option for me and that waiting six months should not be a concern. And remember, my cancer was significantly more aggressive than your husband's. My cancer had extended outside of the capsule of my prostate, it had Cribriform and was Gleason 4+3.

I remember, when I asked the Radiation Oncologist what he would do in my circumstance, he said that he would opt of surgery over radiation because of the adverse side effects of ADT that would be part of the radiation therapy.

I also asked him if he would opt to pay for surgery out of pocket to get it early and he had a humorous response, but he meant it. He said: No, I would use the money to go on a long cruise and would wait for surgery in six months without worrying about it.

In summary, from the information you provided your husbands cancer does not have aggressive characteristics and from my research and consults, I do not think waiting six months for surgery is too long. In your husbands circumstance, I would not consider taking ADT before surgery. The side effects of ADT are supposed to be very unpleasant.

Finally, make sure your husband is getting the Robot Assisted Radical Prostatectomy or RARP surgery.

I really believe that your surgeon is giving you good advice. My surgery was originally scheduled to be six months from my biopsy, like your husband's. I consulted widely before my surgery. I spoke to two Urologists here in Alberta, and I travelled to the Mayo Clinic in Florida to have private consults with another Urologist and a Radiation Oncologist. All agreed that surgery was the best option for me and that waiting six months should not be a concern. And remember, my cancer was significantly more aggressive than your husband's. My cancer had extended outside of the capsule of my prostate, it had Cribriform and was Gleason 4+3.

I remember, when I asked the Radiation Oncologist what he would do in my circumstance, he said that he would opt of surgery over radiation because of the adverse side effects of ADT that would be part of the radiation therapy.

I also asked him if he would opt to pay for surgery out of pocket to get it early and he had a humorous response, but he meant it. He said: No, I would use the money to go on a long cruise and would wait for surgery in six months without worrying about it.

In summary, from the information you provided your husbands cancer does not have aggressive characteristics and from my research and consults, I do not think waiting six months for surgery is too long. In your husbands circumstance, I would not consider taking ADT before surgery. The side effects of ADT are supposed to be very unpleasant.

Finally, make sure your husband is getting the Robot Assisted Radical Prostatectomy or RARP surgery.

Hi, thanks so much for your reply. that made me feel much better Sir! I have consulted with 2 other Urologists (paid) and they said waiting 6 months should be ok but not like a year or more. Now I do have access to Bicalutate or any other ADT of my choice but I read that they could cause acute kidney damage. Since my husband already has been diagnosed with stage I renal disease (through an ultrasound, kidney function is normal though creatinine is on the borderline 1.2) i am in a dilemma as to whether opt for ADT before surgery...

Instead of ADT, you could consider estradiol. A recent study called the patch study found that taking estradiol Was just as effective as ADT and had many fewer side effects. People lived just as long whether they were on estrogen or ADT.

You can look up information about it on the web, and here are a couple of links to check about it.
https://www.urotoday.com/categories-media/2101-centers-of-excellence/localized-prostate-cancer-coe/4308-patch-trial-evaluates-transdermal-estradiol-in-non-metastatic-prostate-cancer-duncan-gilbert.html
https://www.renalandurologynews.com/news/transdermal-estradiol-may-offer-another-option-for-high-risk-prostate-cancer/

Thanks so much for taking the trouble to reply! I will look it up Sir.

Thanks so much for taking the trouble to reply! I will look it up Sir.

If you take estradiol (estrogen) It can cause breast tenderness, and growth in men. Having a short dose of radiation to the chest, before starting estrogen, will prevent that from happening. Radiation Oncologist are very familiar with this.

even with the transdermal?

It’s estrogen that’s causing the problem and if you use any type of estrogen, you still have that as an issue.