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PI-RADS 4 lesion

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Posted 2/28/2017 10:34 PM (GMT 0)
My husband's PSA has been rising for almost two years now. He has had two sets of biopsies and ultrasounds - negative for cancer. His MRI shows a PI-RADS 4 lesion but his urologist wants him to have a fusion biopsy. I am not quite sure why the urologist does not want to go directly to surgery rather than getting another biopsy. Just wondering if anyone else has had this issue. He is 66, PSA 9, no symptoms. Thank you so much!
Posted 2/28/2017 10:55 PM (GMT 0)
I am sure others with experience will give you more details. For my understanding, PI-RADS 4 lesion doesn't mean he has cancer, only biopsy can tell. I have heard many with PI-RADS 5 but no cancer. ( that exactly what I wish for my husband) Last July, husband's MRI shows a PI-RAD 5 and fusion biopsy found no cancer but fats. (DRE normal, PAS 18.80) For the safe side, he is going to take another MRI this Thursday and fusion biopsy a week afterwards. Going directly to surgery is way overreacted and overtreated. Just stay calm for the time being.
Let's hope for the best!
Posted 2/28/2017 11:37 PM (GMT 0)
What I have found is that a PIRAD 4 is suspicious for clinically significant cancer but thats it. Not much research out there quantifying what that is. What I have seen is 30-60% turn out to be clinically significant cancer but that also means 40-70% of the time it is not. Also because this technology is relatively new the results are very dependent on the experience of the radiologists. PIRAD 5 seems to be more reliable in predicting clinically significant cancer but that is also not 100%.
Posted 3/1/2017 12:06 AM (GMT 0)
Please read "2 years AS Results so far" by Jimbo 58 on page 3. He has 2 PI-RAD 5 and found no cancer under 40 needle biopsy. Good luck!
Posted 3/1/2017 12:13 AM (GMT 0)
I don't think any urologist would recommend surgery based on an MRI. MRIs can only show suspicious areas, not cancer. If you really want to be sure, he can get a template mapping biopsy.
Posted 3/3/2017 10:45 PM (GMT 0)
http://www.ctu.mrc.ac.uk/research_areas/study_details.aspx?s=126


Here is some research I found on the PIRAD system for those of you still wanting more information.
Posted 3/3/2017 11:26 PM (GMT 0)
Wilhar, as others have stated, there are many cases of PIRADS 4 lesions where multiple biopsies have not found any cancer. And, even if a biopsy does find some cancer, it may be low risk, and not require treatment, but surveillance. Take a deep breath, and let his doctor proceed with the fusion biopsy.
Posted 9/6/2019 8:34 AM (GMT 0)
My partner had raised PSA levels on 2 tests and his MRI showed a tiny lesion on his prostate on other side of where they usually see them and they say he has PI-RADS 4 yet he has no symptoms, his 'wee' test was the best they had seen at the hospital, they want him to go for a biopsy, but a few years ago they sent him for a liver one saying it was nothing and well it was he had to be admitted because the pain was totally unbearable so for this he went for a consultation only and said no to the biopsy; they said it could be a cancer that doesn't need treating, but the letter said with this level they were saying it was but he hasn't made a biopsy appointment and I am worried and we have a young child and neither of us want it to be serious or lose him. How would I get him to go for it without coming across as a nag which will make him not go even more? Surrounding him at the moment his brother was recently diagnosed with Eosophagal cancer and his sister has Emphysema and just been in hospital with pneumonia so yes I have total empathy with the worries he has on his head and other things but I want him to be OK too. All the comments I have read have been very reassuring and I hope all of you worried out there and who have this are all OK and doing well. Take care here's to great support and brilliant treatment.
Posted 9/6/2019 10:19 AM (GMT 0)
I doubt any surgeon would remove a prostate without a diagnosis of cancer and I'm sure no insurance would pay for that procedure. I have had 2 MRI's and both have found what the radiologist labeled a PIRADS-5 lesion. I have now had 3 biopsies with the most recent in July where I ended up with over 90 core samples and still no cancer diagnosis. I too have no symptoms of any sort but a very high PSA number.
Posted 9/6/2019 12:43 PM (GMT 0)
LC, you have posted on an old thread. I will lock this one and start a new one just for you.

Jim
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