Need advice on Post RALP Pathology Report that includes cribriform

Nothing mitigates cribriform if they are large. I would suggest that you definitely ask for clarification regarding the size of cribriform and also a second opinion might be useful.

There are some definitely positive things in your pathology, like negative margins and no EPE etc.

Since nothing is worrisome beside cribriform ( and IF they are big), nobody will suggest for you adjuvant, especially if you first uPSA comes back undetectable. My husband had much more troublesome findings and he was advised not to do adjuvant due to extra toxicity that happens before area healed properly after RP. Results with adjuvant and early salvage are basically the same but with less toxicity involved.

I would only suggest that you do monthly uPSA for the first year to check for possible BCR (we did it on our own) but all else is written "in the stars" at this point. Nobody can predict what happens in the future with much certainty , not for gleason 7 or 9 - results are all over the place. Yes, cribriform is always "bad news", even small give slightly higher risk for BCR but negligible in comparison with large ones.

Right now try to relax and heal completely and just ask for second opinion to be on the safe side and later on be vigilant with PSA tests. I am not a doctor, but with all of that I read and experienced, that is what I would do.

Wishing you fast and complete healing and ZERO BCR ever 🍀

Thanks for the reply. From my reading I also gathered that adjuvant would not be recommended but I thought it was worth the question to this group anyway. Thanks for the advice on the PSA tests but I'm not sure how my stress hormones might react month after month but it is something to think about to stay on top of it. Thanks again for the reply!

@gordon624

You are very welcome, please always feel free to ask us whatever you wish to ask. Also, ask your doctors relentlessly until you get answers and a clear direction. At the end, you will make a plan according to your preferences and your comfort level 👍 and those parameters are equally important too.

Here is my story:
PCa Dx in May 2023:
MRI in April 23 detected malignity tumor of size 1.2 cm, PI-RADS 4. MRI showed no sign of cancer on pelvis area and neighboring lymph nodes.
Biopsy 2. may 23. Results:
PSA day before biopsy: 6.2
3 out of 10 confirmed cancer in peripheral zone right side GS: 2 x 3+3 and 1 x 3+4 (GP4 - 40%) . Clinical stage: T2a.
RALP in 6. June 23:
Histology results:
tumor location & size: Right dorsal lateral / 14 x 8 mm
tumor type: Acinar adenocarcinoma
presence of Intraductal carcinoma: positive
number of tumors: 1
Gleason score 4+3 (70% pattern 4 with cribriform morphology)
EPE: negative, SV: negative, microscopic bladder neck and lympho-vascular infiltration: negative, surgical margins: negative, pT2
GS is upgraded to 4+3. In addition the pattern 4 is now found to be of type Intraductal cribriform.
3 months post RALP performed adjuvant lymph node dissection, due to upgrade of cancer. 9 nodes are removed and examined. no cancer detected.
PSA <0.1 (6 weeks post RALP)
PSA <0.1 (1 year post RALP, June 2024)
PSA ultrasensitive < 0.006 (18. September 2024)
PSA <0.01 (12. Dec.2024)
PSA <0.01 (1, April 2025)
PSA 0.008 Ultrasensitive (21. May 2025)
PSA <0.01 (10. Aug. 2025)
9. Sep 2025 : PSA <0.01 ng/mL - AFP <1.82 ng/mL - CA19-9 =10.4 U/mL - CEA = 1.6 ng/mL - S100 melanoma cancer marker 0.19ng/ml (S-100 shall be under <0.15 ng/ml)
PSA <0.01 (13, November 2025)
PSA <0.01 (16, December 2025) - S100 melanoma cancer marker 0.14ng/ml (16, December 2025)
PSA 0.01 (20, January 2026)
PSA < 0,1 (19. February 2026)
PSA 0.01 (25, April 2026)
Unfortunately the less sign is gone in last two tests and cribriform is Large, see picture. I am afraid that the cancer is coming back. I insisted for adjuvant rad. and ADT after RALP, but MO wanted to wait and watch PSA. (However I got 9 lymph node dissection that showed no cancer).

@frank1964
The April 2026 PSA result is what you would consider quite good, an undetectable result.

You went to another place in February and they only did A standard test, not an ultra sensitive.

You have nothing to worry about. You could go another year or two before it even begins to rise much at all. The doubling rate is what counts and you have no doubling rate to talk about

@frank1964 You were getting them monthly and stopped?

@dhasper

I live in Norway and unfortunately they do not perform ultrasensitive PSA test. All PSA below 0.1 is reported as PSA < 0.1 . Ultrasensitive tests you see above are taken during my trips to other countries in Europe. (so sporadic)

@frank1964
Thanks for sharing your case , it is always interesting to hear what and how it is done in other countries.

Lucky you that you had an option of having glands removed and examined months after surgery. My husband's gleason was upgraded from 4+3 unfavorable to 4+5 and nobody payed any attention. They did not remove any glands during surgery either, even though his biopsy showed both cribriform and IDC and we asked surgeon to take some glands out for examination.

I am wishing you forever remission and may you never have BCR 🍀.

@surftohealth88 Yeah, this is the second instance ( that I am aware of) of lymph node dissection post RARP, rather than SRT…both in European countries.
Phil