Cribriform patterns

At age 46, in November 2016, I was diagnosed with prostate cancer and had a radical prostatectomy.  My pathology report was pT3bN0M0 and my Gleason Score was upgraded to 9(4+5).

My post surgery PSA was 0.014.   Then tested every 3 months - 0.015, 0.019, 0.023.  At that stage, my Oncologist said something was definitely going on.

A poor pathology report and 3 PSA raises in a row were enough to get her concerned, even though the PSA itself was very low indeed.

 I was an NHS patient and way back in January 2018 my trust agreed to refer me to one of the two London hospitals (NHS) which was doing  PSMA scans at that time.  They accepted the referral but said they couldn't specify a wait time. 

I paid £2586 for a private Ga68 PSMA scan.  My Oncologist warned me I'd probably be wasting my money but was in favour of the scan.

It worked and found 2 spots of cancer in 2 nodes.  Salvage radiotherapy followed.

My PSA  immediately fell to >0.006, the lowest the machine could read.  It has stayed at this level for 6 years running.  

I had 18 months of bicalutimide (hormone therapy) which started before and ended after the salvage radiotherapy.

I hope my story offers everyone hope.

Edited by member 30 Nov 2024 at 16:44  | Reason: Not specified

Henrik,

You are unfortunately correct about the information and studies regarding cribriform.  On one side it’s like so many facets of this disease regarding treatment, having cribriform does not mean Radiation will be unsuccessful, just statistically more resistant to the treatment. That means probably half the people it is successful. Like side effects some get hit hard by all of them and others not so much. I just had my prostatectomy in mid August, post pathology showed cribriform. Gleason actually lowered from 8 to a 7, (4+3). Did have focal EPE. Ended up with negative margins. My first PSA sixty days post surgery was according to my Surgeon undetectable at <.04. 
I have had same concerns about Radiation therapy and HT if I have BCR because of cribriform. I have already made a decision to postpone the treatment as long as I can regardless of PSA increases and wait until something is seen for the Radiation. There are studies that are showing that Image driven treatment  when something is actually seen on a PSMA PET is as successful as PSA driven treatment which has been usually started much sooner. I know this does not affect cribriform resistance but does push your treatment and side effects down the road. It’s always good to be ahead of the game and I think possibly even of only Radiation without the HT as it seems their are always new drugs with less side affects in clinical trials being looked at if mine were to reoccur. For the time being savor your cancer being gone, study your future options if it return's, but don’t spend an inordinate amount of time doing that once you have the understanding what is currently available as god willing it does not return.

Hi again Henrik.

If I get BCR, I've planned to do the same as you and Ned. No HT and RT only when it can be targeted.

This recent article shows conundrums with cribriform patterns.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9675397/

Unless I've misinterpreted it, there are two types: intraductual carcinoma of the prostate (IDCP)  and  invasive cribriform. They are often found together but it is difficult and costly to distinguish between them. It appears that since 2014, if either is found it is automatically recorded as Gleason 4. However, it appears that the effects of the two types of cribriform are quite different.

Likewise previous research I've done shows that if comedonecrosis is found, no matter how small, it recorded as Gleason 5.

The link, I've given suggests that the effects of cribriform is therefore slightly inconclusive?

Does it mean that every person with a gleason score containing grade 4 has cribriform? Likewise does every person with a score containing 5 have comedonecrosis?

If a person has a score containing a Gleason grade 4 do they have IDCP or the more dangerous invasive cribriform or a combination of the two?

Ps:  Nowadays, my hedonistic weekends are restricted to having a couple of Stella's and cracking a phial of Invicorp. 😁

Edited by member 23 Nov 2024 at 07:24  | Reason: Add link

They want to be doing more PSMA-PET scans here, but in the NHS at least, there's a significant shortage of tracer production capacity.

Actually, over the last month or so, there's been a massive shortage of Technetium 99 (used for nuclear bone scans), because 3 out of 4 of the EU's nuclear reactors which produce the Molybdemen 99 precursor have been down. We have no ability for producing that in the UK, but Wales is considering building a reactor to do so.

Edited by member 23 Nov 2024 at 18:13  | Reason: Not specified