Decision time

I don't have advise to give, not much of an expert myself. But really appreciate your post here, I've been on AS for 4 years now and might have to make a similar decision myself someday. I will be reading all the responses. Best of luck to you!

Well, you hit the bell. Cribriform can make your 3+4, a 3+5 or 4+5. It can really make it more aggressive.

Cribriform refers to a specific growth pattern of cancer cells characterized by the formation of multiple, small, hole-like structures within a solid mass of cells. This pattern is considered an indicator of aggressive cancer and is often associated with higher Gleason scores and poorer outcomes.

Cribriform patterns are linked to increased risks of metastasis (cancer spreading to other parts of the body) and disease-specific death, particularly in men with Gleason score 7 (3+4) prostate cancer.

Radiation is not always fully effective on cribriform depends on the extent and size of the cribriform.

Active surveillance is not a good option at this point, your decipher score also says don’t wait.

Small cribriform is not as aggressive but still a danger.

It is frequently recommended to get radical prostatectomy if you have cribriform. That way if I they don’t get all of it, they can use radiation to complete the job. This is something a couple of people in this forum are facing now.

Speak to doctors about what technique works best. Focal therapy may be discouraged, A lot depends on your biopsy results.

I wish you luck.

I'm not a medical professional and I have no idea what's best for you. That said, I agree with you and I would NOT consider continuing AS. With cribriform and 3 lestions at 3+4=7, while I wouldn't suggest rushing I do believe you need to decide on a primary treatment approach and pursue it. I had some bad family history so when I was diagnosed I already had a strong bias towards my treatment path. However, I think a smarter approach would be to get several recommendations from CCOE's, including both surgeons and non-surgeons. Hopefully that would help you decide which path might be best for you. Best Wishes.

I saw a RO yesterday and discussed all treatment options noted above. For my situation, he likes Brachytherapy LDR or HDR. It sounds interesting. Any thoughts??

Brachytherapy has been discussed as one of the options used to really eliminate Cribriform. I know that in at least one other case they first had IMRT then brachytherapy.

You could discuss this combination with the doctor to see if it might be more effective.

From this AI search. “ can imrt followed by brachytherapy be used to eliminate cribriform”

A combination of Intensity-Modulated Radiation Therapy (IMRT) and brachytherapy is a viable treatment option for prostate cancer with cribriform features. This aggressive combination is often used for higher-risk cancers, such as those with cribriform patterns, to increase the radiation dose to the tumor while minimizing side effects.

If you do that search yourself, you will find a lot more information than this one Paragraph.