Newly diagnosed

Posted by carlsbadguy @carlsbadguy, 2 days ago

Hello, I’ve been lurking on this forum since I received the results of my MRI. I’m 73, my PSA jumped from 3.22 to 4.37 in a year. Referred to a Urologist who ran another more complex PSA test which showed a jump, in less than 60 days, to 5.1 with a free PSA of 19%. I had a TRUS biopsy 10 days ago and received the following results during a video call with my Urologist this past Fri, 4/24/26. He is a highly regarded Urologist/Surgeon who has performed hundreds of Da Vinci RPs. He stated that at my age and with my diagnosis RT and ADT would be the better course of treatment.

During the biopsy he took 12 cores, six from each lobe. No cancer found in the left lobe, but 3 of the 6 on the right showed cancer, and a 4th was close. I have a consultation scheduled with an RO, waiting to hear from my MO to schedule. I’m in the Scripps system in San Diego, they have assigned a Nurse Navigator who is helping me navigate the process. I understand that everyone’s journey is different, mine appears as if it might be pretty rocky. I would appreciate any input.

G. Prostate, right medial base, core biopsy:
Prostatic adenocarcinoma, Gleason score 4+3 = 7 (grade group 3) in 1/1 core, involving 25% of the biopsied tissue and measuring 5 mm in length.
Percentage of Gleason pattern 4: 80%
Cribriform pattern present
Intraductal carcinoma

J. Prostate, right lateral base, core biopsy:
Prostatic adenocarcinoma, Gleason score 4+3 = 7 (grade group 3) in 1/1 core, involving 40% of the biopsied tissue and measuring 7 mm in length.
Percentage of Gleason pattern 4: 70%
Cribriform pattern present
Intraductal carcinoma

K. Prostate, right lateral mid, core biopsy:
Prostatic adenocarcinoma, Gleason score 4+4 = 8 (grade group 4) in 1/1 core, involving 20% of the biopsied tissue and measuring 3 mm in length.
Atypical intraductal proliferation

L. Prostate, right lateral apex, core biopsy:
Focal high-grade prostatic intraepithelial neoplasia (PIN)

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for rlpostrp @rlpostrp

Hello - I totally agree with what @jeff marc (Jeff Marchi) offers: "There is a problem with treating both intraductal and cribriform as that there is no treatment that is definitive in eliminating it. Surgery was probably better than radiation for Cribriform. But radiation might be usable if you had SBRT radiation followed by multiple sessions of IMRT to the prostate bed and lymph nodes. You need to discuss this with both a urologist surgeon and a radiation oncologist to find out what may be better for you." I totally agree that a radical prostatectomy is the better way to go.
I would add that while you have Intraductal carcinoma, it is still important to know and understand "which type" of Cribriform tissue that you have...and for a reason and outcome that I discovered quite unexpectedly when I did a little research to discover that there are about "eight" types of Cribriform tissue, two of which are nothing to worry about, AND that Cribriform tissue can exist as a "normal" microscopic feature in healthy prostate tissue in some men. In other words, you could have had Cribriform tissue all of your life, and when you got diagnosed with prostate cancer, with Cribriform tissue, that Cribriform tissue may have been there all along. Here is what happened with me:
I wanted to know more about Cribriform tissue, so I did an online search, and much to my surprise, I discovered the above mentioned fact that there are numerous types of Cribriform tissue, but...my post-RP surgical pathology report merely said: "Cribriform: Present". I called my urologist and asked him to have my slides pulled and re-read by the same pathologist so he could tell me what type of Cribriform tissue I have. Outcome: The pathologist modified his original surgical pathology report, correcting himself, that there was in fact NO Cribriform tissue in my prostate tissue"...per my urologist quoting the pathologist, he had made an overly conservative call and decided to say it was there, when upon re-examination, decided that he was wrong, and thus amended his own report. THAT did not instill much confidence in me as to the skill of the pathologist. So...It might be worth having your slides re-read, maybe by a different pathologist with the request to delineate "what type" of Cribriform tissue you have, because it may be "normal" Cribriform tissue.
As I mentioned above, two types are not problematic, while the others span a range of moderately problematic to ominous. It would be good to know, for peace of mind, what you have. I thoroughly believe in maximal understanding of everything about my cancer, so that when new decisions have to be made, I have "ALL" of the history and knowledge about "me" that I can possibly have. I fortunately did not have Intraductal Carcinoma, but I did have Extraprostatic Extension (EPE), left seminal vesicle invasion, and surgical margins which were only found after my prostate was removed and dissected. The left seminal vesicle invasion threw me into a more ominous pT3b category which my doctor told me, means that I have a 25-50% probability of the cancer returning "within" five years. I am hoping I will be in the 50-75% group where it does NOT recur. Good luck to you...keep us posted on your progress.

Jump to this post

@rlpostrp
I did some queries on this, and I cannot find anywhere that they say that there are eight types of cribriform.

There are two basic types invasive cribriform carcinoma and intraductal carcinoma of the prostate (IDCP). Now you can have small or large cribriform But they are the same type just different sizes.

There are some other types that are not really considered Cribriform yet, Atypical Cribriform Lesion (ACL) / Atypical Intraductal Proliferation (AIDCP). Those are types of tissue that they say you should have further biopsies to see if Cribriform is really found.

When I query”are there eight types”, the answer is “No, there are not 8 distinct types of cribriform patterns generally recognized in prostate cancer biopsies.

Current literature and uropathology guidelines, including those from the International Society of Urological Pathology (ISUP), typically classify cribriform prostate cancer into two major, distinct morphological categories based on their invasive potential, which are both associated with poor prognosis and require aggressive management:
PubMed Central (PMC) (.gov)

Do you have a link to this eight types of cribriform?

REPLY

I'll try to create and drop the link, but here is a screenshot of the article title and authors below my list of the eight types of Cribriform that exist:
1. Clear Cell Hyperplasia Cribriform
2. AIDCP Cribriform
3. IDC-dense Cribriform
4. IDC-nuclear artypia (atypia?) Cribriform
5. IDC-comedonecrosis Cribriform
6. Cribriform Pattern 4
7. Cribriform Pattern 5
8. Ductal Carcinoma Cribriform

From MDPI (journal?)

Cribriform Patterned Lesions in the Prostate Gland with Emphasis on Differential Diagnosis and Clinical Significance
by Maria Destouni 1, Andreas C. Lazaris 2ORCID and Vasiliki Tzelepi 3,*ORCID
Department of Cytopathology, Hippokrateion General Hospital of Athens, 11527 Athens, Greece
First Department of Pathology, School of Medicine, The National and Kapodistrian University of Athens, 11527 Athens, Greece
Department of Pathology, School of Medicine, University of Patras, 26504 Patras, Greece
Author to whom correspondence should be addressed.
Cancers 2022, 14(13), 3041; https://doi.org/10.3390/cancers14133041
Submission received: 22 May 2022 / Revised: 14 June 2022 / Accepted: 20 June 2022 / Published: 21 June 2022

REPLY

https://www.mdpi.com/2072-6694/14/13/3041
Link to MDPI article on the types of Cribriform tissue that exist.

REPLY
Please sign in or register to post a reply.