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What does “cribriform present” mean?

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Posted 6/8/2021 11:21 AM (GMT 0)
Does “cribriform present” in the biopsy report mean it is “ductal” or “intraductal” ? Or cribriform is a subtype of ductal? I am very confused. What is the treatment for it? Thanks.
Posted 6/8/2021 12:26 PM (GMT 0)

116grove said...
Does “cribriform present” in the biopsy report mean it is “ductal” or “intraductal” ? Or cribriform is a subtype of ductal? I am very confused. What is the treatment for it? Thanks.

I don't know a lot about “cribriform present”, but I think treatment is the same, but it is an additional negative finding, like higher G scores and higher PSA etc. In the less severe G7s for ex, (G3+G4=G7), it would rule out active surveillance, although other details of your biopsy may have already done that. Here is one study, but maybe others with more knowledge will be along shortly.

" In conclusion, increased %GG4 is associated with invasive cribriform and/or intraductal carcinoma in GS 3+4=7 prostate cancer biopsies. Invasive cribriform and/or intraductal carcinoma is an independent parameter for BCR after prostatectomy, whereas %GG4 is not. The presence of invasive cribriform and/or intraductal carcinoma has to be included in pathology reports and should act as exclusion criterion for active surveillance. "
https://pubmed.ncbi.nlm.nih.gov/28530220/
Posted 6/8/2021 12:32 PM (GMT 0)
Hi and Welcome to the Forum, 116grove! I am not well versed in these, but can locate and link material that can help you more if you can give us your complete biopsy report.

As I understand it, a cribriform architectural pattern can be seen both in the common "acinar" type of PCa as well as in "ductal/intraductal" PCa. These refer to locations within the architecture of tissue throughout the prostate. The histopathology is rather complex and probably not that important. Does your biopsy make mention of both?

The bottom line is that all PCa can be treated (often definitively) by several means, such as radiation or surgery. Just as important one's Gleason score and these additional findings is whether or not one's PCa is confined to the prostate or not. The prognosis is obviously better if it is.

In recent years there has been interest in both cribriform and ductal/intraductal findings, mainly as prognosticators for other adverse features, such as spread to the lymph nodes. However, I'm seeing some different study results depending on the Gleason score of the biopsy (which in the US is that of the lesion with the highest Gleason score). There is even discussion of incorporating these findings into the Gleason grading system, whereas now they are noted separately.

I'll be happy to post some links if you can provide your biopsy findings in more detail along with any imaging results you've had in your workup. Otherwise there is simply too much information, much of which won't apply to your situation.

Thanks!

Djin
Posted 6/8/2021 12:39 PM (GMT 0)
Again, if you were a G7 being considered for active surveillance only, the presence of cribiform would rule that out and you should get treatment. So, what was the rest of your biopsy report like? What was your Gleason score? Had you been considering active surveillance?
GS7(-) = no cribiform, GS7(+) = cribiform present.
" Results: In total, 486 patients had GS 6 and 310 had GS 7, 54 of whom had GS 7(+) (17%). During a median follow-up of 15 years, biochemical recurrence was seen in 61 (20%) GS 6, 54 (21%) GS 7(-) and 22 (41%) GS 7(+) patients (41%). Both biopsy GS 7(-) and 7(+) patients had significantly higher prostate-specific antigen levels, mean tumour percentage, percentage of positive cores and ≥cT3 than those with GS 6 (all P < .001). GS 7(-) patients did not have a poorer biochemical recurrence-free survival (BCRFS) after radical prostatectomy than GS 6 patients (log-rank P = .13), whereas those with GS 7(+) had (log-rank P = .05). In multivariable analyses, biopsy GS 7(-) was not associated with poorer BCRFS after radical prostatectomy (hazard ratio [HR], 1.3; 95% confidence interval [CI]: 0.67-2.4; P = .47) or radiotherapy (HR, 0.88; 95% CI: 0.51-1.5; P = .63). GS 7(+) was independently associated with poorer BCRFS after radical prostatectomy (HR, 3.0; 95% CI: 1.1-7.8; P = .03), but not after radiotherapy (HR, 1.2; 95% CI: 0.58-2.3; P = .67).

Conclusions: Men with biopsy GS 7(-) prostate cancer have similar BCRFS after radical prostatectomy or radiotherapy to those with GS 6 and may be candidates for active surveillance as long as other inclusion criteria such as on PSA and tumour volume are met."

https://pubmed.ncbi.nlm.nih.gov/27522247/
Posted 6/8/2021 12:43 PM (GMT 0)
Hi Djin,
Thanks for your quick response. This is my biopsy. The PSA before biopsy is 1.78. I have been monitoring PSA for 15 years. It has been never above 2. But after MRI, the lesion was found. Then I got the biopsy.

Please any suggestion. Thanks. I am 71 years old and healthy. Do you think I should have a DECIPHER TEST?

FINAL PATHOLOGIC DIAGNOSIS
MGPUROCRP MGH
location: Institution:
A. PROSTATE BIOPSY, RIGHT POSTERIOR MEDIAL: Prostatic adenocarcinoma
Gleason score 3 + 3 = 6/10 (Grade Group 1)
Number of cores involved: 2 of 3 fragments
Percentage and length of cores involved:2 mm in a 5 mm core (40%) and <1 mm in an 11 mm core (~5%). Perineural invasion is: Present
Note: There is a focal area of glandular complexity in a focus of perineural invasion, which does not contribute to Gleason scoring.
B. PROSTATE BIOPSY, RIGHT POSTERIOR LATERAL:
Prostatic adenocarcinoma
Gleason score 3 + 4 = 7/10 (Grade Group 2); Percent Grade 4 (%): 40% Cribriform growth is: Present
Number of cores involved: 1 of 2
Percentage and length of cores involved: 6 mm in a 15 mm core (40%) Perineural invasion is: Present
C. PROSTATE BIOPSY, RIGHT BASE: Benign prostatic tissue.
D. PROSTATE BIOPSY, RIGHT ANTERIOR MEDIAL: Benign prostatic tissue.
E. PROSTATE BIOPSY, RIGHT ANTERIOR LATERAL: Prostatic adenocarcinoma
Gleason score 4 + 5 = 9/10 (Grade Group 5);
Cribriform growth is: Present
Number of cores involved: 2 of 2
Percentage and length of cores involved: 8 mm in a 16 mm core (50%) and 5 mm in a 10 mm core (50%) Perineural invasion is: Present
F. PROSTATE BIOPSY, LEFT POSTERIOR MEDIAL: Benign prostatic tissue.
G. PROSTATE BIOPSY, RIGHT POSTERIOR LATERAL: Benign prostatic tissue.
H. PROSTATE BIOPSY, LEFT BASE: Benign prostatic tissue.
I. PROSTATE BIOPSY, LEFT ANTERIOR MEDIAL: Benign prostatic tissue.
J. PROSTATE BIOPSY, LEFT ANTERIOR LATERAL: Benign prostatic tissue.
K. PROSTATE BIOPSY, TARGET RIGHT APEX:
Prostatic adenocarcinoma
Gleason score 4 + 3 = 7/10 (Grade Group 3); Percent Grade 4 (%): 80%
Cribriform growth is: Present
Number of cores involved: 3 of 3
Percentage and length of cores involved: 7 mm in an 11 mm core (~65%), 6 mm in an 11 mm core (~55%), and discontinuously involving 6 mm in a 10 mm core (60%)
Perineural invasion is: Present
Posted 6/8/2021 12:57 PM (GMT 0)
By the way, the biopsy report did not mention “ductal” or “intraductual” or normal. I am planing to have surgery, due to my high risk grade. AS is absolutely not my choice. The reason I select RP is that MRI did not find other lesions, except the one on right apex. All my lesions are on the right lobe. I am afraid RT or other treatments will be missing other lesions. By the way, from the recurrence view, it is said 0.2 psa will be regarded as threshold. But for my case, it has never over 2ng/ML. Do I still need this value as watch my cancer recurrence? Unfortunately, all current scan equipment, even 68GA or Pylarify, could not find any tiny tumor as psa value is too low. Any suggestion? Thanks.
Posted 6/8/2021 1:06 PM (GMT 0)
My PSA records:
2007 1.0 ng/ml
2008 0.9 ng/ml
2009 1.39 ng/ml
2010 1.20 ng/ml
2011 1.01 ng/ml
2012 1.26 ng/ml
2013 1.34 ng/ml
2014 1.57 ng/ml
2015  n/a
2016  n/a
2017 1.61 ng/ml
2018 1.09 ng/ml
2019 1.14 ng/ml
2020 1.79 ng/ml
Posted 6/8/2021 1:10 PM (GMT 0)
What pops out in your report, and basically sums it up, is this description of one lesion:

"Gleason score 4 + 5 = 9/10 (Grade Group 5);
Cribriform growth is: Present"

Of course active surveillance is not on the table. IMO you are to young for watchful waiting, especially with your diagnosis.

Grade 9 prostate cancer must, of course, be taken very seriously, and when it occurs in men with very low PSA's like yours, it can be aggressive. I think a concern in your workup will be determining if there are any metastases.

Were there any enlarged lymph nodes on your MRI?

You might want to discuss an advanced scan -- such as a 68Ga-PSMA-PET or an 18F-based scan -- with your docs to help with the metastasis issue. These are being increasingly used in the diagnostic phase and not just in cases of cancer recurrence.

IMO a Decipher scan can wait until you've decided on your primary treatment. If your opt for RP, it should wait and be done on your RP tissue (Decipher Biopsy results agree with the Decipher RP results only 70% of the time.) If you opt for radiation, the Decipher test will have to be done on your biopsied tissue, but it can be done at any time, unless you decide that the results would help you make your treatment choice.

IMO, the important question now becomes Is your PCa confined to the prostate? PCa can spread locally out from the prostate and still not be metastatic. And metastatic PCa can be limited to pelvic nodes.

I'm sure there will be ample discussion here about treatment for high-risk/high-grade men, but your workup needs to be completed before weighing delving into the RP vs RT question. I do think RP (followed by adjuvant therapy if needed) is a good choice, unless there are currently metastases outside the pelvis.

Much will depend on whether or not you need adjuvant therapy (RT +/- ADT) after RP. Adjuvant will be advised if you have (1) even one of the four main adverse findings: lymph node invasion (LNI), extraprostatic extention (EPE), positive surgical margin(s) (PSM), or seminal vesicles invasion (SVI) or (2) if you have persistent PSA after surgery.

Djin
Posted 6/8/2021 1:23 PM (GMT 0)
This is from my MRI REPORT:
PROSTATE VOLUME
Measurement via DynaCad gland segmentation: 28 cc
PROSTATE: 12 x 7 mm T2 hypointense, diffusion restricting, ADC
hypointense, early enhancing lesion in the right posterior lateral
peripheral zone at the apex (5:11). No frank extracapsular extension
however ill-defined prostate capsule and borderline wide abutment
increases the risk of underlying extracapsular extension.
SEMINAL VESICLES: Unremarkable.
LYMPH NODES: No pelvic adenopathy.
BLADDER: Unremarkable.
PELVIS: No free fluid.
RECTUM: Unremarkable.

Bone scan is clear. Psma scan is available.
Posted 6/8/2021 1:28 PM (GMT 0)
I would discuss the advisability of a PSMA scan with your docs. IMO it's good to have as much information about one's cancer as possible.

It was smart of your doc to pursue the MRI and biopsy after your PSA jump even though you had been nearly as high in the past!

Djin
Posted 6/8/2021 1:38 PM (GMT 0)
Just by chance in the annual physical. My primary doc found my PSA is a little bit higher than previous year (from 1.14 to 1.78), then he sent me for MRI. When MRI found a lesion 4, I was referred to the urologist for biopsy. Otherwise I would have never known my PCa till now! Of course I feel some problem for pee.
Posted 6/8/2021 1:43 PM (GMT 0)
Your prostate size doesn't suggest BPH, but from what I understand, whether excess growth is directed outward (with little bother) or inward and impinges the urethra is somewhat independent of absolute prostate size.

High-grade, low PSA prostate cancer is serious but very difficult to diagnose. You are unlucky to be among us G9 men, but are very lucky it was discovered!

Djin
Posted 6/8/2021 1:43 PM (GMT 0)
116Grove, I am curious - you say it was the MRI that led to the biopsy, but what led to the MRI? With a 15 year history of PSA never exceeding 2, why would you go looking for PCa? Of course, it is good that, since it was there, that it was found and is being treated. But I would think statistically that an MRI on a man with that PSA history would rarely find anything.
Posted 6/8/2021 1:56 PM (GMT 0)
I am lucky. Many people, including my urologist, wonder why my primary doctor sent me to MRI. PSA elevated? My age or his feeling? I don not know. Anyway, it is the time for me to make many decisions.
Posted 6/8/2021 2:02 PM (GMT 0)
By the way.I was not visiting my primary doc for PCa, but for the annual physical, including lung, liver, colon, as well as psa. All others are OK, but psa to MRI gave me a shock! The whole life is in mess.
Posted 6/8/2021 2:07 PM (GMT 0)
The PCa diagnosis came as a shock to all of us, but you will come through this. We are here to help.

Djin
Posted 6/8/2021 2:11 PM (GMT 0)
Thanks anybody for your thoughtfulness.
Posted 6/8/2021 2:42 PM (GMT 0)

DjinTonic said...
I would discuss the advisability of a PSMA scan with your docs. IMO it's good to have as much information about one's cancer as possible.

It was smart of your doc to pursue the MRI and biopsy after your PSA jump even though you had been nearly as high in the past!

Djin


Absolutely. If you can get a PSMA scan, do so.
Posted 6/8/2021 3:31 PM (GMT 0)
I think you are the first person I have heard of with a cribriform finding from a biopsy report. I’d get a second opinion.
Posted 6/8/2021 3:43 PM (GMT 0)
Welcome to our club, glad you found us. At this point, I'd suggest the same basic things we suggest all newbies, and newly diagnosed men....

You're doing a lot of the right things. Getting your scans done, asking questions. With the G9, treatment is absolutely in your very near future. It's important that you make a truly informed decision. With that in mind, do consult with one or more radiation oncologists about your case. It sounds like you've only consulted with a urologist, who is by definition a surgeon. Your comment about going for surgery because of your G9 and your age sounds like a surgeon's recommendation.

The Radiation experts can explain the different radiation options to you, as well as the potential downsides and side effects. They are the experts on their specialty. Do that, then make your treatment decision. It's important and valuable.
Posted 6/8/2021 4:08 PM (GMT 0)
Cribriform pattern is not that uncommon a biopsy finding; however, it's reporting is not required and it is often omitted.

Communicating prostate biopsy results[/url (2021, Full Text)

On cribriform prostate cancer (2018, Full Text)

"Final recommendations

❖ Ask your pathologist to specifically report the presence of cribriform growth in the pathology report.

❖ Consider using cribriform growth as an exclusion criterion for active surveillance in Gleason score 3+4=7 patients."

Djin
Posted 6/8/2021 4:09 PM (GMT 0)
I realize that this may fall on deaf ears...but here goes...for once oh wise and caring forum members...can we let... what appears to be a a smart fellow...quite up on his heath awareness regimen...just for once...let himself choose his treatment...now that would be a breath of fresh air for most...yada yada blah blah...
Posted 6/8/2021 4:14 PM (GMT 0)

logoslidat said...
I realize that this may fall on deaf ears...but here goes...for once oh wise and caring forum members...can we let... what appears to be a a smart fellow...quite up on his heath awareness regimen...just for once...let himself choose his treatment...now that would be a breath of fresh air for most...yada yada blah blah...

No, we are going to organize a team of Healingwell brothers to restrain him and administer the majority Forum treatment choice.

I said a choice of treatment is best delayed until the diagnostic workup is complete. The OP said "I am planing to have surgery, due to my high risk grade."

Djin
Posted 6/8/2021 4:15 PM (GMT 0)
Welcome to the forum

You will get a lot of information and support here.

Glen Heinsohn
Posted 6/8/2021 4:32 PM (GMT 0)

halbert said...
Welcome to our club, glad you found us. At this point, I'd suggest the same basic things we suggest all newbies, and newly diagnosed men....

You're doing a lot of the right things. Getting your scans done, asking questions. With the G9, treatment is absolutely in your very near future. It's important that you make a truly informed decision. With that in mind, do consult with one or more radiation oncologists about your case. It sounds like you've only consulted with a urologist, who is by definition a surgeon. Your comment about going for surgery because of your G9 and your age sounds like a surgeon's recommendation.

The Radiation experts can explain the different radiation options to you, as well as the potential downsides and side effects. They are the experts on their specialty. Do that, then make your treatment decision. It's important and valuable.

Hello, 116 and welcome. Sorry you have to be here but we will help in any way we can. My only other comment is simply to agree with the advice you got above from Halbert.

Jim
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