What do you trust, the MRI showing Pi Rads5 or the biopsy of same area showing Grade 1, GS6?

It makes no sense to me and my husband. We are just getting into all this PCa information but this has been on our minds. How can they be so different when the biopsy was done with URONAV technology(MRI fusion biopsy)? BTW-I plan to post all of my husbands info as soon as we gather it. This is a wonderful site. Thank you.

Thanks a bunch Pratoman. We have been learning so much from this site. We also read what we should do when first diagnosed and are following through; we are waiting for our 2nd opinion on slides from Dr. Epstein. When that comes in we will try and put together a decent signature. My hubby is 65 and was just diagnosed Dec. 17th 2015 in Rochester, NY.

MRI

I'm going to venture that you had the biopsy first...am I right?

Biopsy, of course. MRI only identifies suspicious areas worthy of further investigation. Usually they take some extra cores from the suspicious area, just to be sure. mpMRI identifies areas with odd texture, fluid flow and blood supply, but does not detect cancer per se. You should have that confirmed by Bostwick or Epstein (and only them).

If confirmed, he'll probably opt for active surveillance, and they can check that area again in a year.

Sheepguy, actually my husband sees a uro at SMH and we had the Uronav there with the MRI just before that at a facility not too far from Strong. We have an appt. to meet with Wilmot Cancer Ctr MDs next week. It will be our uro doc , an RO and an MO. That's kinda why we are reading so much on this site and elsewhere to at least be able to carry on some sort of a conversation with the 3 of them. We are looking at Roswell and Upstate and Sloan. I am trying to copy the MRI results and pathology report here for anyone to view but having some difficulty. Copy and paste doesn't work for this. Any ideas? (We scanned them to our desktop already)

There are several guys here who are in the Rochester area who may be able to answer local specific questions. There are some great facilities in the area.

Inquisitive One, I was diagnosed a year ago and had a Robotically Assisted Laproscopic Prostatectomy (RALP). I am an engineer with an interest in medicine and my Father passed from Prostate Cancer in 1999. I have been doing my homework. I agree with others here that the MRI is not the definitive test. The biopsy allows a pathologist to stage the cancer which is critical to selecting a treatment option. Further, PC is multi focal, it is super common to have a lot of small tumors, not just one or two big ones. The MRI can miss the small ones. Best Regards, Pat

Thank you everyone.

Here are the MRI findings and impression.

The prostate measures 42cc in size. There is diffusely decreased T2 signal in the peripheral zone likely representing prostatitis. No abnormal restricted diffusion is demonstrated in the peripheral zone.
The transitional zone demonstrates diffuse nodular heterogeneity compatible with BPH. There is a 1.8 cm nodule within the right anterior base demonstrating ill-defined T2 hypointense signal. This lesion demonstrates corresponding restricted diffusion and type III kinetics, likely representing a PIRADS 5 lesion. There is a 1.3 cm area of ill-defined T2 hypointensity near the anterior midline in the mid gland, which demonstrates mild restricted diffusion and is compatible with a PIRADS 3 lesion.
The seminal vesicles and neurovascular bundles are symmetric in appearance.
No definite lymphadenopathy is demonstrated.
No suspicious osseous lesions are seen.
The bladder is well distended and within normal limits.

Well, good luck with all this stuff. Sounds like both of us will be running around upstate NY trying to figure out what the heck to do next. Maybe our paths will cross somewhere. :) It does sound like the MRI didn't do a heck of a lot of good..it might have discovered what it is not supposed to be good at...low grade gleason and missed the G7 but then with all this prostate stuff it seems like anything can miss anything, you just never know. Fun, ain't it?

My husband and I are open to everything. We really don't know what the docs will have to say but we both know that we need to gather information before making this decision. It may be AS or LDR or SBRT. If we need intervention my husband seems to like the SBRT. Seeing how well Tall Allen has done it keeps it in the running. BUT, still waiting on results from Dr. Epstein which may change things. At least we have been learning about all the therapies available. My husband does not want surgery. He is 65, 5'9" weighs 156 only a few pounds heavier than he was when we married 36 yrs ago. Very lean and muscular. He has always been a healthy person eating raw veggies and nuts and good fats before it was fashionable. Has been doing Nordic-Trak and running and exercising for decades which is why the whole family is so surprised to hear about this. He has no other heath issues, no diabetes, no heart issues, no elevated BP, nothing. No prostate cancer in his family at all. One thing for sure that we learned from reading here is that we are in charge and we will make the final decision which therapy we use not the docs. They can suggest but we will decide. I looked online at Roswell in Buffalo and it looks like the use Varian Trilogy for SBRT(?). At least that what it says on their webpage. We looked at Upstate in Syracuse webpage and they use the Varian TrueBeam which I believe is the later version and uses pellets for guidance versus black magic marker for skin marking. Am I correct here? Read somewhere the pellets more accurate. IDK for sure though. Hopefully someone can guide us here. It is surprising Roswell advertises an older version Varian and Upstate which is not one of the big comp. cancer ctrs is possibly using something better(?) It is very hard to figure it all out. After our visit next week at Wilmot, and with Dr. Epstein's pathology we can get some good guidance here and be on our way to a few places with a better list of questions to ask. We've already sent our med record to upstate so it's ready when and if we seek advice there. We called Dr. Zalefsky's office at Sloan and asked time frame for new appts and they said as of now about 3 weeks out. So we are lining our ducks up in a row.
Sheepguy-what are your plans? Have you visited Roswell or Upstate or Wilmot or Sloan?

Inquis,

Upstate has the new BrainLab Vero for SBRT, better still than Varian Trubeam..they have had it only a couple of years so I'm hoping they have someone who knows how to use it ! Better, I say, I should probably say "supposedly". The brand new cancer center at upstate is attracting some good talent my uro says. Not sure why Roswell seems somewhat antiquated..but I'm willing to "spend a day" with them just to see what they say. At present I hope to stay on AS for a while..3 cores G6 < 5%, PSA up to 6 , then 8, now 7..???
I'm a sheep farmer so I can't go too far so probably Wilmot, Roswell and Upstate. Like your husband, I cannot really do surgery..can't be "out " for 8 weeks.

I had heard that it costs about 2 grand and isn't covered by insurance ????

NYSHIP..for retired state employees,( my wife )Empire to UHS to BCBS

How did you find out about the Spaceoar at Upstate?