Cribriform Pattern 4

vjs
vjs Member Posts: 5 Member
edited June 3 in Prostate Cancer #1

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.

«1

Comments

  • Clevelandguy
    Clevelandguy Member Posts: 1,180 Member
    #2

    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
    vjs Member Posts: 5 Member
    #3

    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
    Clevelandguy Member Posts: 1,180 Member
    #4

    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
    Steve1961 Member Posts: 618 Member
    edited April 5 #5

    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
    Rob.Ski Member Posts: 172 Member
    #6

    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
    Old Salt Member Posts: 1,505 Member
    #7

    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
    Steve1961 Member Posts: 618 Member
    #8
    https://csn.cancer.org/discussion/comment/1714445#Comment_1714445

    sometimes thats all it takes

  • Steve1961
    Steve1961 Member Posts: 618 Member
    #9
    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
    Steve1961 Member Posts: 618 Member
    #10
    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
    vjs Member Posts: 5 Member
    #11

    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
    Josephg Member Posts: 455 Member
    #12

    @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
    Old Salt Member Posts: 1,505 Member
    #13
    https://csn.cancer.org/discussion/comment/1714508#Comment_1714508

    You are on the right path; keep going!

  • laojia
    laojia Member Posts: 10 Member
    #14

    how is Cribriform detected. My MRI and biopsy as well as PSMA-pet did not mention weather Cribriform present or not present. I am waiting for Decipher result. I was diagnosed with 4+3, localized.

    from my biopsy report:

    The Gleason pattern 4 types identified include poorly formed and fused
    gland types with mucinous features

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #15

    The pathologist (assuming he/she is qualified) who examines the slides from the biopsy should report cribriform if present.

  • Steve1961
    Steve1961 Member Posts: 618 Member
    #16
    https://csn.cancer.org/discussion/comment/1714532#Comment_1714532

    excuse me i have been told they are finding cribiform is radiation resistant.lperiod how do you explain that the tumor right next to the marker is still there and it is all gleason 4 cribiform..i will warn EVERY SINGLE man with cribiform to be learry about radiation thank you very much…

  • Steve1961
    Steve1961 Member Posts: 618 Member
    #17

    Decifer testing will tell you for sure

  • jc5549
    jc5549 Member Posts: 57 Member
    edited May 31 #18

    I feel there is value to all comments in this thread. Cribiform pattern changes do suggest more aggressive Gleason 4 pattern disease. The changes are found by the Pathologist when your biopsy cores are examined under a microscope. As Dave 3+4 points out, it is very important to distinguish Intraductal vs Non-intraductal cribiform pattern because the Intraductal type appears to be radio-resistant.
    The Decifer test does look at your biopsy specimen, but will not comment on cribiform changes, however, it does correlate very highly in terms of placing you in a higher risk group if you do have negative prognostic variables like cribiform changes (article link): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208239/

    I believe Steve1961’s passion and cautionary tale comes from someone who was NOT, “one and done.” Of course it is possible any of us may require follow on therapy due to PSA recurrence. Part of the reason I chose surgery first is my belief that radiation after surgery is far better than the reverse order should I experience a PSA failure in the years to come.
    Hope you find the right treatment for you, none of the interventions is a free lunch.
    jc

  • csjchas
    csjchas Member Posts: 7 Member
    #19

    I am coming up on my one year mark post surgery… 4+4 with crib. I have done more research on cribriform than most urologists… my surgeon joked that I basically went to med school. To say the least I am extremely disappointed in the lack of attention to this pattern of cancer and it is my belief that the reason for this is that the current treatment options are not as successful… which include pharma, oncology and surgery… $$$.

    My surgeon told me that crib had a 72% chance of BCR within five years after surgery. He even called the pathologists after surgery to confirm for the third time that I had crib. If any of your doctors tell you that crib is just another type of 4 then get another opinion.

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    edited May 31 #20

    I wrote this earlier in another thread on cribriform pathology (slightly edited)

    It's complicated; cribriform prostate cancer, that is.

    There seem to be two kinds with the one that is associated with intraductal carcinoma being the more aggressive one.

    Conclusions: Cribriform pattern with intraductal carcinoma was associated with adverse outcomes in men with Gleason 7 prostate cancer treated with external beam radiotherapy while cribriform pattern without intraductal carcinoma was not so associated. Future studies may benefit from dichotomizing these 2 histological entities.

    The above conclusion is from this paper:

    https://pubmed.ncbi.nlm.nih.gov/31059665/

    PS: Noticed a lot of papers in PubMed on this topic in the last few years…

  • jc5549
    jc5549 Member Posts: 57 Member
    #21
    https://csn.cancer.org/discussion/comment/1715694#Comment_1715694

    Sorry Old Salt. I may have failed to credit you with the difference between Cribiform types.

    jc

Discussion Boards