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Post-Surgery Path Question (Cribriform)

Hellostone
Posts: 22
Joined: Jan 2020

Greetings, it's been awhile but I am one week past my RALP which seems to have gone well notwithstanding current Covid risks and anxiety, and from which the recovery to date has been as expected. 

I've already received the pathology results and was greatly cheered to learn there were negative margins and no EPE or SVI. I remained scored as G4+3 with plenty of pattern 4 (i.e., 90%), pT2 N0.  That seemed about the best news I could get at this point.

However, there was this additional note on the report:  Invasive cribriform carcinoma is present. 

How meaningfully adverse is that finding -- is it an additional quantum of risk that raises my odds of a BCR even further, or is it more of an expected finding given my high volume of pattern 4 cells?  From a very little research, I have read that cribriform is highly associated with Biochemical recurrence (BCR) and disease specific mortality, which is worrisome even though I don't really understand it.  

So what is cribriform anyway??

My thanks and best wishes,

HS

Clevelandguy
Posts: 590
Joined: Jun 2015

Hi,

See post below

Clevelandguy
Posts: 590
Joined: Jun 2015

Hi,

Cribriform means a pattern of cells with many swiss cheese type holes in it.  Cribriform with a 4+3 means that there is a greater chance of cancer reoccurrence than a person with say a 3+4 and no cribiform. With that said each case is different and I would think that you will have to follow up like all of us do with PSA tests and if needed more scans. From what I have read is that it makes the cancer more agressive.  I have attached a link to a article about 4+3 with Cribiform.  Hit the back to button lower right of graph to read the article.  

https://www.nature.com/articles/s41379-018-0157-9

Dave 3+4

Steve1961
Posts: 301
Joined: Dec 2017

I know we want to try and help but do you think that's what he really wanted to see ...

Cribriform growth is highly predictive for postoperative metastasis and disease-specific death in Gleason score 7 prostate cancer

VascodaGama's picture
VascodaGama
Posts: 3234
Joined: Nov 2010

Stone,

I prefer to give you my comment in your initial thread because it includes our exchanged opinions and data since your diagnosis that may influence the way we judge it.

Please see it in here;

https://csn.cancer.org/node/321128

Best,

VG

Steve1961
Posts: 301
Joined: Dec 2017

So after the 3rd opinion of my biopsy ..I was told I had cribiform ...my dr I think was trying to appease me by saying I have simple cribiform and  not invasive cribiform ...really never heard of simple  cribiform ...when you look up cribiform all u see is invasive cribifirm..I don't want to call him  out because ge is highly respected well known surgeon But I think he is lying to me 

hewhositsoncushions
Posts: 361
Joined: Mar 2017

My research and advice suggests it is simply a diagnostic market for G4. If it was worse it would be G5

Hellostone
Posts: 22
Joined: Jan 2020

Thanks guys, I appreciate these posts, particularly the link from Cleveland. I'd seen that or a similar study and so I wasn't that surprised by the rather ominous headline. 

That said, I'm certainly hoping that hewhosits is closer to the mark and that the cribriform notation on my report was Sort of part and parcel of having lots of G4 cells, rather than a new, indepedent (and adverse) variable to factor in. Will obviously be talking further with my doc at my follow up next month.  Perhaps this will result in some gene testing like Decipher...can they do genomic testing on post-surgery pathology tissue?

Thanks again!

hewhositsoncushions
Posts: 361
Joined: Mar 2017

The way I see it is that the staging and what treatment they offer tells you how good or bad they think the situation is which incorporates all the known pathology.

In most cases if it is really serious e.g. small cell, they will be up front and tell you what the situation is. They will generally give you an estimate on LX if that is a consideration.

Consultants will not lie or withold information or play things up or down. They cannot afford to as they would get sued.

Basically each of us has a guide to where we are on the scale of things and the rest is in the lap of the gods and our willingness to foght and be fit

Hellostone
Posts: 22
Joined: Jan 2020

Thank you hewhosits. I very much agree and love your closing statement. You might consider an alternative name:  hewhohaswaywithwords. 

Clevelandguy
Posts: 590
Joined: Jun 2015

Hi,

Just keep up your visits with your doctors and see how it goes.  No one knows whether you will have it any rougher than a 3+4 with no cribiform. The best thing any of us can do is monitor after surgery or radiation.  Hopefully we will all progress with minimal side effects and problems.  Like they say life is a crap shoot, you don't know which way it will go until you throw the dice. Good luck..........

Dave 3+4

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