Very interesting pathology report about cribiform

That is ridiculous !!!!

Having either cribriform (especially large ones) or IDC always points to aggressiveness of a cancer so much so that for example "3+4 favorable" with cribriform becomes "4+3 UNfavorable" or according to some doctors 4 even becomes 5 - that is HOW much it is disadvantageous to have them and how important to report them .

Now, not all pathologists are well informed or have updated training ! All of those facts are actually recent discoveries and if that lab did not have "retraining" of their stuff, that is unconscionable >: (

If neither patient nor a doctor are informed that cribriforom or IDC are present how on earth than they can make any informed decision about future treatments ?????

Also - his statement that all 4 gleason slides have cribriform is FALSE ! What center is that ??? Please send me PM , I really wish to know where NOT to go.
Only about 6% of all biopsy slides find cribriform.

I agree it's very important and should be considered for treatment. This is why I was surprised. I tried to PM you but it wouldn't allow me to?
All I can say is both of the centers of excellence are in Phila and in the top 15 cancer centers in US. Like I posted that quote in previous post came from a well renown Chief of Pathology. My thought was maybe cribiform was present in all 4's but maybe very small or large?

Cribriform patterns are often under-detected in initial biopsies due to sampling limitations.
Prostate Needle Biopsy: Typically found in 6% to 15.2% of cases.
Radical Prostatectomy (Surgery): Found in 21.4% to 69% of cases.
Research indicates that roughly 40% of patients who test negative for cribriform patterns on a biopsy are later found to have them in surgical specimens.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
+4

@jetgator So like 40% of all cases have cribriform in surgical specimens?
Yet another thing we thought we knew, but really didn’t!🤣😩

After having seen cribriform in multiple reports from multiple people I would say it’s time to find a different place to get your treatment. My brother was a 4+3 and they reported cribriform on his, Fortunately, it was not large cribriform.

I’ve seen so many biopsy reports In this forum that showed cribriform or even said there was no cribriform I would be suspicious about the place you were being treated.

You can always request a second opinion on your biopsy. Here is info on two doctors that are really well known for their competence in reading biopsies.

Dr. Epstein biopsy
https://advanceduropathology.com
Dr. Zhou

Send an email to Ming.zhou@mountsinai.org to inquire about a second opinion and ask for his specific instructions for the process.

My biopsy path didn't mention cribriform, , I sent the slides to Johns Hopkins for 2nd opinion. It confirmed my 3+4 Gleason and added the note " no large cribriform seen". I then had surgery at Mayo and my path upgraded my Gleason to 4+3(65% 4), tertiery 5, and just noted that cribriform glands "present". I guess my original biopsy missed the bad stuff. The "present" has me wondering. It didn't say anything about "large". I'm 29 months post at < .1

@keywest19 Yes, biopsy can miss tings - no doubt about that ! It is only 50% correct - other half are either downgraded or upgraded AFTER prostatectomy. Still, my husband had a SINGLE positive core with 3+4 and cribriform were found and noted and the sampling and report was done in local "medium grade" hospital, nothing to write home about. Slide was sent to UCSF for second opinion and all findings were the same and cribriform noted and reported !

So, even though my husband had very low tumor burden a single core with 4) and small % of gleason 4 in that sample, his 3+4 was immediately upgraded to 4+3 UNFAVORABLE due to cribrifororm glands present and he was advised to have fast and aggressive treatment. They were right since that single place with cribriform turned out to be actually gleaoson 5 since some cells started to die off in that spot !

Anyhow - "head of that department" is covering up their mistake.

@jetgator - you did not see that "100% have it" - right ? If it is even 50% that have cribriform than 50% do not have it.

I agree with @jeffmarc - they are trying to cover their mistake, period !!! They omitted to report the finding and now are downplaying their omission !

@copyman

Thanks for trying to send PM - sometimes it is not possible to send PM for new members until about 6-8 weeks pass since joining (for security reasons). I am on a West Coast so your info given is sufficient < 3.

Regardless of what "chief' said" ; ), what is important for you to know is IF you have cribriform or not and all the rest is now irrelevant : ). And no, not all 4s have cribriform, (small or large).

Small cribriform are less aggressive in a sense that they do not tend to produce metastases if removed on time (with time they become large cribriform). So even though it is MUCH better to have small cribriform than big ones, their presence is unwelcome finding in a biopsy and since biopsy samples only about 1% of the whole gland, nobody can guaranty that some parts do not have occasional large one.

@heavyphil

Yeh, it seems ALL methodology in diagnosing and staging PC is on a level of divination !!!! HONESTLY ???? : / *sheeeeshhhh

I knew that they find much more stuff once that gland is removed, that was one of the reasons why we wanted RP, but ... How we now know that even all that comes AFTER diagnosis is still not just "throwing of the beans and bones on a dirt floor", XP and just waiting to see IF and WHAT "sticks" !? ; )

I never drink - but I honestly think I need a drink now XP lol lol

My biopsy was analyzed by my local urologist (or whatever lab they used), MD Anderson, and Cleveland Clinic. All three said 3+4 and no cribriform. Post-op pathology at CC last June showed large cribriform (and SVI) but still 3+4. The shift from T1C at biopsy to post-op pT3b was disappointing but life rolls on. Undetectable PSA so far.