Does the presence of cribiform histology at biopsy in prostate cancer affect your management in an otherwise intermediate-risk prostate cancer?

There have been no trials on this specific question, so there is room for debate and more science (hoping our recent grant submission in this area gets funded...). Here is my current thinking. This is for generally healthy patients with long life expectancy (≥10 years, but especially if ≥15 years). And everything here applies to intraductal carcinoma (IDC), as well, as IDC was included in the definition of cribriform morphology in recent papers.

1. No active surveillance for cribriform/IDC. Cribrif...

Here’s my opinion: A PSMA PET scan is important before deciding treatment options. Thanks to modern screening and more accurate staging at diagnosis, we have seen a stage shift toward earlier detection and clinically localized disease. If micrometastatic on PSMA PET, I recommend radiation and ADT. If high-volume metastasis, I recommend systemic therapy. If localized, most patients with a cribriform pattern are still successfully cured through surgical resection. I perform same-day discharge robo...