Can MRI Confirm BX Gleason Score?

My urologist daVinci surgeon ordered an endorectal coil MRI before surgery because one side of my prostate was hard, i.e., a tumor. He said the MRI was extremely helpful during surgery, helped him visualize the tumor. I'm glad for that but whatever they infused me with (for contrast I assume) made me feel really lousy. And they had a hard time inserting the device, altogether a very unpleasant experience.

The only thing an image can show is size and structure. To find the gleason score you have to put a sample under a microscope.

tutor paul-

mpMRIs are only good for finding areas suspicious for high grade (GS 7-10) cancer. They may sometimes detect GS6 areas if they are large enough, but they are actually much worse than a TRUS-guided biopsy for that. That's why they almost always take random cores as well during an mpMRI-targeted biopsy.

It's not just the mpMRI - you need an experienced radiologist. There's quite a difference in PIRADS scores between experienced and unexperienced radiologists.

I had 3T MpMRI and only one suspicious area was found and targeted for the biopsy. So with the standard 12 core plus 1 targeted core the MpMRI came back negative for cancer. Yet the biopsy showed 7 out of 13 cores to be positive for low yeld GS 6 and GS7 (3+4).

So the bottom line the MpMRI can find higher yield cancers and tumors, but it isn't very sensitive for low yield cancers.

tutor_paul, Yes, G6 lesions can show up on MRI's.

All my MRI's have shown those areas, which several targeted biopsies have shown to be either G6, HGPIN, atypical cells, or negative. So, yes, the "target" areas for G6 have always shown up, at least in my case.

Here is something I found. Seems like the PIRAD 5 is more predictable of significant cancer. Seems like a good adjunct to treatment to reduce random biopsies.

Introduction and Objective: We aim to determine what proportion of PIRADS 4 or 5 lesions on MRI represent prostate cancer based on cognitive fusion transperineal biopsy.

Materials and Methods: Patients with a PIRADS 4 or 5 lesion on MRI who underwent cognitive fusion transperineal biopsy from April 2014 to March 2015 were included. MRI findings were correlated with transperineal biopsy histopathology.

Results: Thirty one patients were identified with PIRADS 4 (11) or 5 (20) lesions.

Forty-five percent of PIRADS 4 and 100% PIRADS 5 were confirmed to be cancer on biopsy.

Clinically significant prostate cancers defined as Gleason ≥ 3+4 or ≥4mm maximum core length (University College London definition 2) was detected in 23 patients (36% PIRADS 4 and 95% PIRADS 5).

For PIRADS 5 lesions 9 men had Gleason 3+3 (8 clinically significant), 3 Gleason 3+4, 4 Gleason 4+3 and 4 Gleason ≥8 cancer confirmed in the location of MRI lesion.

For PIRADS 4 lesions 2 Gleason 3+3 (low volume) and 3 Gleason 3+4 cancer were diagnosed.

Thirteen patients were on active surveillance for low volume Gleason 6 (10) and low volume Gleason 7 (3) disease. Eleven (85%) patients upstaged their cancer in grade/volume and 7 (54%) patients had biopsy results leading to active treatment (1 EBRT and 6 RALP).

Eleven lesions were predominantly anterior. Thirteen men had previous benign TRUS biopsies (7 with PIRADS 5) of median 2 previous biopsies (range 1-3). Eight (62%) had biopsy positive for clinically significant cancer. Ten (77%) were predominantly anterior lesions. Conclusion: Clinically significant prostate cancer was identified in 36% of PIRADS 4 lesions and 90% of PIRADS 5 lesions. Cognitive fusion transperineal biopsy is useful in upstaging patients on active surveillance

elsa, you might want to copy this to a new topic/thread. This looks interesting and should have its own thread.

tutor-paul,

I've found that a prostate cancer support group can be a good way of sticking with it. I think a lot of guys get comments from well meaning family, friends, and co-workers, who really don't understand. Encouragement from people who do understand is a good antidote.

I have found that PCa support groups were very welcoming to me. They wanted to know all about my case, and often expressed wishes that their doctors had mentioned AS as an option to them. By all means, try to attend them.