Cribriform Pattern 4

vjs

I've recently been diagnosed with Stage 2 Prostate cancer (Gleason 3+4= 7) with evidence of Cribriform pattern 4 (5% & 10%) in 5 areas of my prostate. I had twenty core samples taken in my biopsy and there is no evidence of intraductal carcinoma.

My urologist strongly recommends radiation treatment and feels confident that radiation treatment will destroy the cancer as he describes my cancer as a low/intermediate stage. He feels we caught it at an early stage and can be effectively treated with radiation.

I've been reading literature recently and I have concerns about Cribriform pattern 4 and its ability to withstand radiation and re-occur. I'll be meeting with a radiation oncologist shortly ( at Penn Medicine)and I want to be prepared as much as possible to intelligently discuss my options.

Does anyone on this board have experience with Cribriform pattern 4 and radiation treatment versus surgurical removal of the prostate. Any literature or anecdotal information on how best to treat it would be appreciated.

Thanks for any feedback.

Clevelandguy

Hi,

From the studies I have read non intraductal cribiform can be treated successfully with external beam radiation. A second opinion from another health care network might not be a bad idea. Cyberknife or Proton beam radiation are to very good tupes of EBRT. If you have reservations about EBRT why not a robotic surgical removal? I have included a link for you to look at.
https://www.redjournal.org/article/S0360-3016(19)32610-0/fulltext

Dave 3+4

vjs

Thanks for your response.

My urologist has said the side effects of RP, my current health state (very good), and a cancer he thinks can be cured with radiation argued against RP. Apparently, the rate of remorse following RP is fairly high based on studies I've read.

Frankly, surgical removal scares me and radiation seems less invasive. However, I have read several articles where radiation success treating Cribriform is understudied and unclear.

I'm meeting with a radiation Oncologist next week and I'll ask the same questions. Apparently, Cribriform is the real curveball for me.

Thanks for sending the link; I'll review it now.

Also, I really appreciate you taking the time to reach out. All still new to me at this early stage of accepting the diagnosis.

Clevelandguy

Hi,

Most side effects from surgery start immediately and get better over time(ED & urine leakage) where radiation side effects are low after treatment but can increase as months/ years go by. No guarantee on severity of side effects from either procedure. Get the best facilities and doctors to get the best results. The side effects are different for each procedure so research those so you know what to exspect.

Dave 3+4

Steve1961

NO NO NO NO I AM LIVING PROOF . CRIBIFORM IS RADIATION RESISTANT….I WAS IN THE SAME BOAT 6 YEARS AG0…/I DID ERBT WITH A BRACHYBOOSTER..NOW I AM ON MY COUCH RECOVERING FROM SALVAGE SURGERY DAY 4 HOPING TO GOD ITS NOT TOO LATE.6 YEARS AGO I WAS 58 PSA 7.6 3+4 CRIBIFORM,,,,,LAST YEAR PSA WENT FROM A LOW OF 0.9 AFTER 5 LONG YEARSSSSSS TO 1.9 IN A YEAR..psma SCAN MRI BIOPSY ALL CONFIRMED 4+4 CRIBIFORM RIGHT NEXT TO THE MARKER WHERE IT WAS TARGETED BY RADIATION …OF COURSE THE RADIOLOGIST WONT ADMIT IT ..I KNEW IT I DIDNT TRUST HIM… I HAVE 2 SURGEONS WHO HAPPEN TO BE PROFESSORS AND DIRECTERS OF PC AT UCLA AND UCSF DR ROBERT REITER AND DR PETER CARROLL LOOK THEM UP 2 OF THE BEST IN THE NATION SAYING THAT ARE SEEING ALOT OF EVIDENCE CRIBIFORM IS RADIATION RESISTANT…U ARE PLAYING WITH FIRE ..THIS IS MY LAST CHANCE IF IT COMES BACK I CANT DO RADITION AGAIN BUT YOU CAN//3 STEPS TO pROSTATE CANCER STEP 1 SURGERY STEP 2 IFFFF IT COMES BACK RADIATION..STEP 3 HORMONE TREATMENT.. SURGERY IS THE GOLD STANDARD LOOK IT UP…MESSAGE ME IF YOU WANT TO CHAT MORE..I WOULD HATE TO SEE ANY MAN MAKE THE SAME MISTAKE I DID ..REMEMBER RADIOLOGISTS ARE NOT PC SPECIALISTS MY 2 SURGEONS ARE PC SPECIALISTS..IN FACT THE FIRST RADIOLOGIST I SAW TOLD ME TO HAVE IT REMOVED I SHOULD HAVE LISTENED TO HIM

ASK YOUR RADIOLOGIST HOW MANY CASES HE HAS TREATED WITH CRIBIFORM..ASK HIM WHAT THE SUCCESS RATE WAS..I GUARANTEE YOU HE WONT BE ABLE TO ANSWER YOU AND HE WILL BEAT AROUND THE BUSH SORRY GETTING UPSET AGAIN

ALSO HOW OLD ARE YOU DO YOU EXPECT TO LIVE 10 OR MORE YEARS..WHAT WAS YOUR PSA TUMOR SIZE TO PROSTATE VOLUME//THESE ARE IMPORTANT FACTS TO KNOW AND DISCUSS ALSO WHERE ARE YOU LOCATED HAVE YOU GONE TO A BIG INSTITUTE AND FIND A SURGEON WITH 20 OR MOREYEARS WITH 3000 OR MORE SURGERIES UNDER THEIR BELT ..KEEP IN TOUCH….

Rob.Ski

I had RP. No remorse. Find a skilled surgeon with lots of procedures under his/her belt and see what they say. Ask for that surgeons results vs. General information. You may find radiation is what you want to do but, I wouldn't base decision based on what your urologist said about remorse for side effects. Like Dave said radiation can have side effects too. Get as much info as you can to make your most informed decision.

Old Salt

It would be best to discuss the implications of the cribriform pattern finding with a (well recognized) radiation oncologist, rather than relying on a report from one patient on this forum.

Steve1961

https://csn.cancer.org/discussion/comment/1714445#Comment_1714445

sometimes thats all it takes

Steve1961

https://csn.cancer.org/discussion/comment/1714445#Comment_1714445

with alldo respect i asked my radiologist that question ..he had only done radiation on few men with cribiform..he didnt even keep track of them he told me they were fine ..all he did was beat around the bush and told me what i wanted to hear .li should have asked him if youwere me knowing what we know what would you do and why …but i didnt….oh btw yhe dr is a well recognized radiologist and from what i am told they dont take into consideration decifer testing

Steve1961

https://csn.cancer.org/discussion/comment/1714445#Comment_1714445

excuse me sir ..i am living proof …it is becoming known over the last few years that cribiform can be radiation resistant i have had 2 top PC cancer specialists tell me that ..the evidence with me is quite clear .i questioned my radiologist extensively about cribiform and he stright up lied to me …i will take the word of my surgeon from UCLA any day Academic/Professional Titles

• Professor, Urology, Molecular Biology,
• Director of the Prostate Cancer Program
• Director of Urologic Research
• Co-Director of the Genitourinary Oncology Program in UCLA's Jonsson Cancer Center
• 
  sometimes the word and experience from 1 patient is all you need

vjs

I want to thank you all for your passionate thoughts and suggestions.

I'm 69, stage 2, last PSA 5.2, 3+4=7 Gleason and Cribriform pattern (5-10%). I'm meeting with the head of radiation therapy at Penn Medicine on April 12. My urologist at Penn answered my question about what would he do if he were me with a response that he would choose radiation ( and he's a surgeon). He felt strongly I'm curable as the Cribriform is a relatively small %, and that radiation could be a "one and done" for me. Of course I'm concerned he could be wrong which is why I'm taking the approach many of you above recommend.

Per the suggestions above I am going to ask very specific questions about the success this physician has had ( and Penn as had overall) treating patients with cribriform pattern 4, how many patients have they seen with cribriform (apparently Penn see a lot per the urologist),what is the radiation treatment they recommend specific for me, etc.

I haven't completely ruled out surgery but I'm leaning to radiation therapy. I will look up Dr. Reiter and Dr. Carroll and I'll mention them to my physician as well.

Josephg

@Steve1961 "sometimes the word and experience from 1 patient is all you need"

This comment is blatantly wrong. Have you learned anything at all from this Forum since you joined?

Old Salt

https://csn.cancer.org/discussion/comment/1714508#Comment_1714508

You are on the right path; keep going!