Newby in PNW Favorable vs Unfavorable Intermediate

In a study I went to a few months ago they discussed. Cribriform And the fact that even if you had a 3+4 Gleason, it was much more aggressive than that, more like you had a five in one of your numbers. I have a link so you could listen to it if you’re interested.
https://www.urotoday.com/video-lectures/a-journal-club-for-patients-with-prostate-cancer/video/mediaitem/4452-unfavorable-histology-classification-aims-to-reduce-unnecessary-treatment-journal-club-jesse-mckenney-jane-nguyen-cornelia-ding.html
You should get genetic testing as soon as possible. You can get it done for free here
http://Prostatecancerpromise.org
They will send you a kit to see if there’s any genetic issues. Takes about three weeks and a genetic counselor will call you about the results.

Instead of ADT, you could use estradiol patches or gel. The patch trial just completed and showed it worked just as well as ADT but had fewer side effects.
Getting on ADT soon would prevent your cancer from growing for a little while at least.

You should get a second opinion to see if there are other options. These type of treatments would allow you to have radiation after you had the treatment HIFU , Cryoabalation , NanoKnife , TULSA PRO, HoLEP. Many people in this forum have used Tulsa pro and found that it was very effective. One person just yesterday mentioned that they had cribriform and they also had Tulsa Pro to eliminate the cancer, So you would possibly be eligible for it.

Are you dealing with a Genito urinary oncologist? Medical oncologist worked on all different types of cancer, whereas the GU Oncologist specializes in prostate cancer and keeps up with all the latest things going on. You might consider getting a second opinion at a center of excellence.

I am also "unfavorable intermediate." The oncologist is arranging a date for my SBRT; I was not prescribed ADT for prior to treatment, but will be on hormone therapy while SBRT treatment is ongoing, and months (or year/s) afterwards.

I think jeffmarc covered it thoroughly. Cribriform does make it more aggressive and intraductal cribriform, even more so.
You should ask about HDR brachytherapy in conjunction with SBRT. It is high dose seeds placed in the tumor for a short period of time (45 mins or so) to REALLY hit the cribriform cells hard. Then perhaps a week to 10 days later you start SBRT for 5 sessions. I met 3 men at Sloan who were having this done - all with Gleason scores similar to yours.
Really push for intense treatment since many studies in the past have shown poor outcomes with cribriform cells present. But RO’s are much more informed now and success rates are invariably higher.
The addition of ADT also very important in your case. Please let us know how you fare!
Phil

Thanks for the cribriform link. I had not read the difference between large cell vs small cell anywhere else. I'm looking forward to the consult at Fred Hutchinson and hope it doesn't come across as a sales pitch similar to the Compass consult. Only had a brief discussion with Mayo as I researched HIFU and was told the extracapsular extension eliminated that treatment as an option. With regards to genetic testing - I thought I covered that with my decipher score. Did I miss something? Maybe an odd thing to say or believe - but I honestly don't care if there"s cancer within me - as long as it doesn't interfere with my life as I know it......same goes for the various treatment options. So many choices & opinions. Just give me 20 more years of independence and I'll be fine.

Genetic testing is to check if you have something like BRCA2, ATM, RB1, pten, TP53 or other genetic flaws. It can change how you’re treated If you do have certain types of genetic anomalies.

What do you think about getting tested after having completed treatment?

I got tested for the first time 11 years after I started treatment. Already had surgery and radiation and years of drugs. They found BRCA2.

I am at a point now where if the drug I’m taking fails, I can move onto a PARP Inhibitor which can prevent The cancer from growing for a while. If I did not have BRCA2, which they found four years ago, I would not be able to benefit from a PARP inhibitor.

Besides the heredity test, you do a somatic test if you need further treatment in the future. It will tell whether or not genetic changes have occurred in your cancer, which could be treated.

Ordered

Thank you for your input and I'm going to join this research today and get this ball rolling. Hopefully I will have results before my next PSA test in 3 months.