Biopsy results showing Intraductal Carcinoma

Hi DJN. I am also intraductal and with cribriform P4 variant, intraductal means your cancer started, or is present in the urethra where it passes through the prostate, Cp4  means the cancer cell structure is more open, these are both indicative of a more aggressive variant, though being intraductal and Cp4 does mean the cancer has more chance of spreading, it  DOESN'T mean it has. 

Mine, I'm Gleason 10, was in 5 organs and 8 lymph nodes at diagnosis July 2022, now thanks to HT and RT, my cancer is undetectable apart from being in 1 node, which we hope to zap soon.

Eddie xx 

Thanks for sharing Eddie.

It's all do new and very worrying.

J

Hi DJN, your welcome, we all start off not knowing much about our cancers, and usually thinking the worst, but coming from healthcare I can tell you the advancements in cancer treatments, especially prostate have come on enormously in the last 5 years, with new treatments coming along all the time, your Gleason 4+3 and staging T3a are familiar to many on the forum and often with very good outcomes, and the guys and girls on here will support you however they can, so keep asking questions, and the good people on here will do all they can to help you both through the journey you are starting, best wishes.

Eddie xx

Hi Jane,

I also have a intraductal/cribriform diagnosis which is not great but it is certainly not incurable. My cancer was staged at cT3b N0M0. The last part is important and you really need to get that as well, the bone scan, CT and possibly PET PSMA CT scan will determine that and the health care team will then be able to determine the treatment options.

Either way there are plenty of treatments available but you need to wait a bit for the full diagnosis (sucks, I know).
And I completely understand the anxiety, I remember clearly the sinking feeling when I got the diagnosis and did the research.

For understanding results like this I like to see what chatGPT has to say.
It is often quite good and what it says here corresponds with my understanding (be careful about relying on it too much).

I hope you don't mind but I posted what you wrote above.

The concern about the intraductal carcinoma (IDC-P) and cribriform pattern is understandable, as these features can indicate a more aggressive form of prostate cancer. Here’s a detailed explanation of the findings:

Key Findings:

1. PSA and PSA Density:

   • A PSA of 5.3 μg/L while on finasteride (which halves PSA levels) suggests an actual PSA equivalent of approximately 10.6 μg/L.
   • A PSA density of 0.44 (calculated as PSA divided by prostate volume) is high, with values >0.15 considered significant.

2. MRI and PI-RADS 4:

   • PI-RADS 4 indicates a high suspicion of clinically significant prostate cancer (but not diagnostic).
   • T3a staging suggests extracapsular extension, meaning the tumor has grown outside the prostate capsule but without involvement of nearby organs or lymph nodes.

3. Biopsy Results:

   • Gleason Score: 4+3=7 indicates an intermediate to high-grade tumor. The predominant pattern (4) is more aggressive.
   • 60% Pattern 4: Suggests a significant proportion of the cancer is high-grade.
   • Intraductal Carcinoma (IDC-P): This is a marker of aggressive disease and is associated with a higher risk of progression and recurrence.
   • Cribriform Pattern: This specific pattern within Gleason 4 is associated with worse outcomes compared to non-cribriform Gleason 4.

What This Means:

The presence of IDC-P and cribriform growth means the cancer is likely more aggressive, even if confined locally. These features often lead clinicians to consider more intensive treatment strategies.

Next Steps:

1. Staging Investigations:

   • The bone scan being performed today will check for metastases (spread to bones).
   • Additional imaging (e.g., PSMA PET-CT or CT abdomen/pelvis) may help confirm whether there is any spread.

2. Treatment Considerations:

   • Localized Disease: If confirmed, options include radical prostatectomy or radiotherapy (often with androgen deprivation therapy [ADT] for better control).
   • Advanced Disease: Systemic therapies, like ADT or novel anti-androgens (e.g., abiraterone or enzalutamide), may be necessary.

3. Discussion with Specialists:

   • Consult a multidisciplinary team, including a urologist, oncologist, and radiologist, for a comprehensive treatment plan.

Emotional Support:

Waiting for scan results can be very stressful. Open communication with the care team about timelines and expected steps is crucial. Engaging with support groups or counseling services can help during this time.

Hello Jane DJN 

Let me just add to that great post from  .

Unknown said:

Emotional Support:

You don't say how your husband is feeling but we all suffer anxiety whilst going through the diagnostic stage of the journey.

At Macmillan we can offer your husband free BUPA Counselling if he needs it - link here:

https://www.macmillan.org.uk/cancer-information-and-support/get-help/emotional-help/bupa-counselling-and-emotional-well-being-support

There is also our Support line for both of you - it's a free call on 0808 808 00 00 (8am to 8pm 7 days a week) where we can provide you with some extra support.

If I can help with anything please let me know

Best wishes - Brian.

I just want to add one thing. 

While IDC-P or cribriform patterns are more advanced forms of prostate cancer, this study shows that not all cases are the same. About 25-30% of these cancers behave similarly to typical prostate cancer and respond well to treatment. Treatments are improving, and outcomes can still be good, especially with early and effective management.

https://ascopubs.org/doi/10.1200/JCO.2024.42.16_suppl.e17077

Hi DJN - Jane: first of all;  it is NOT as bad as you think.

I have VERY Similar biopsy results to your OH. Small prostate (26ml), PSA 13, PSA density 50%, widespread cribriform, AIP (suggestive of intraductal carcinoma), core length 11mm, Gleason 4-3 (60% 4).

please read my bio. I’m currently in remission (PSA 0.03) and I feel great. Climbed many mountains this year.  No, I’m not showing off- I tell you this to reassure you that your world is FAR from crashing down.

The aggressive features are in tiny samples of cancer that is only just getting going.  These features merely mean that your consultant will not suggest active surveillance (of that I’m sure: if he or she does, then get another consultant). That is why they are mentioned on the biopsy report- to aid this important decision to move from surveillance to radical treatment.   I would expect your OH to be on a curative pathway very soon (the vast majority of bone scans come back negative, so my fingers are crossed for you). 

PLEASE try not to worry - your OH appears to have been caught early. They’ve found cancer in his small prostate because there’s nowhere to hide!  He’s now safer than the untested man in the street, as the cancer has been found and its little game is up.  Aggressive cancer in those tiny core samples taken from the gland? Fine - it doesn’t matter what grade they are if you’ve got them cornered, because they will be obliterated by radiotherapy (or completely removed and in the pathology lab tray, if he goes for prostatectomy.). In the latter case, be careful, as he is T3a so you must consider any escapees (going walkabout, as Millibob would say.  

SO, chin up, both of you. Get the final scans out of the way, send those little buggers to hell, and resume your lives together.  PS - my OH is called Jane, so we have even more in common!       AW

Hi Jane. I’m also a T3a, N0, M0, PSA 5.3. 4+3(4). Age 57. No symptoms. After research and with some people’s help (especially AW) I chose the Hormone/HDR Brachy/Radiotherapy route. Hormone Treatment started 13/8/23. HDR Brachy op on 15/11/24. My radiotherapy starts on 17/12/24. My PSA is already down to 0.27. You’ve had some amazing advice already that I can’t add to. All I can say is that once the treatment journey starts things get easier. I didn’t take my diagnosis very well. I was in a mess to be honest. Now I feel focused and strong. Best advice I can give is for your husband to stay as fit as he can both pre and during treatment. Walking, light weights, meditation (working in) will really help. My warm wishes to your husband for the best outcome. We’re here if you need us