Help understanding MRI

On re-reading the results of my MRI, I find that the report, in addition to identifying the cancer, includes this: “Bilateral nonspecific noncircumscribed areas of low T2 signal without significant restricted diffusion, nonspecific.”

Can anyone help me understand what this means?

I agree with Andrew. What it says in even more words (but in English) is:

Bilateral=both sides of the prostate
nonspecific noncircumscribed areas=no sharp boundaries
low T2 signal= a texture difference that can be caused by fibrous tissue, calcification, etc.
without significant restricted diffusion=tumors restrict diffusion, so this is good. This is the most important finding.
nonspecific=nothing jumps out that they can define

"only" 800 SBRTs? That's a huge number! The learning curve is nowhere near as steep as for prostatectomy. Radiation with a brachy boost is the standard of care for high risk PC - SBRT is experimental.

They always say they think they can get it all, otherwise they wouldn't recommend surgery. An MRI does not show all that's there. It only shows high grade lesions>4 mm. PC is almost always multi-focal (lots of smaller lesions scattered about). No one can look at an MRI image and know he can get it all. Make sure he as a pathologist standing by to look at frozen sections.

What I took away was that Dr. Mychalczak said was that all of MSK had only performed 800 SBRTs.

Far be it from me to tell anyone what to do, and I'm not one to dissuade anybody from surgery, but Dr. Mychalczak asked a very good question.

Thanks. nyc lawyer, yes, Dr. Mychalczak said, “We have done 800,” from which I inferred all of MSKCC.
JNF, that’s a great result.
This is a very tough decision as all of you know, and I’m grateful for your thoughts.
One of my interpretive challenges is that the RO said “high risk” and wanted me to consider a clinical trial designed for “very high risk” people, for which he said I was borderline eligible, whereas at the surgeon’s office they said “intermediate risk.” The more I read the more I seem between intermediate but unfavorable and high risk.

Facts: 1. clinical stage at repeated DREs was T2a but MRI found probable EPE.
2. Both Hopkins and MSKCC said G4+3, with 5/12 cores positive, all on right side.
3. PSA was 6.5 in July 2011, then 8 in July 2013 Dx BPH, then 23.8 in July 2017 right after prostate-manipulating exercise on X-country skiier, then 20.44 in September 2017 seven weeks after biopsy. Unfortunately not repeated before biopsy. Surgeon thought there would be a residual effect of the biopsy.
Very approximate calculations based on postings here would suggest that main tumor at G7 and 3.6 cc would account for approximately 10.8 of the PSA, and the other 40cc of prostate, if all normal, would be 2.7. If there is BPH it would add something. Since there were leukocytes in urinalysis and high white blood cell count in blood work, and I did not do antibiotics because DRE made biopsy the next step, there could be some prostatitis, although neither CT nor MRI said so. Whatever the rest is, and however much it is, will come, as Tall Allen said, from cancer too small to show up on scans. Or maybe this is over-analyzed.
Why surgery? It offers more definitive diagnosis, my wife and I can accept the SE, and all the docs say I seem healthy enough. Dr. Touijer has done prostatectomies on men older than I with good outcomes.
I wish there was a way to know for sure what to do.

Progressing, I'm just telling you my story i was similar to your stats after biopsy so on that dx surgery looked like it was as good as choice as any although the team at the Mayo offered looking at RT. After surgery well didn't turn out so good as you can see from my signature and am now looking at SRT and probably ADT. I chose Life first Incontinence Second ED issues Third. I was fortunate I had a great Surgeon so am 99% continent kinda worried about what's gonna happen in this dept. after SRT. I would just recommend to you take your time consider all the options factor in your age and what's important to you and then go for it! Best of luck whatever you decide

Larry

A few thoughts as you figure out your treatment options:

Based on the priorities you listed, "life" would probably the same for surgery or the brachy/IMRT combo, given your age and diagnosis. (Although as pointed out, brachy/IMRT has better oncological outcomes.)

"Continence" is probably better for brachy/IMRT.

"Sex" is probably more of a toss-up, but most would say that it's better with brachy/IMRT. It certainly would be in the short-term.

Tall Allen can quote you stats on all of the above. And, of course, everyone responds differently.

Other surgery advantages
As you pointed out, surgery gives you the benefit of a definitive pathology. That's important to a lot of guys. (It never was to me since I didn't see how knowledge after the fact would change my future decision tree, but that's just me.)

You'll know sooner if surgery was effective than if you did radiation.

You have the possibility of avoiding hormone therapy, which is a slog. (Unless you need follow-up radiation.)

Other brachy/IMRT advantages
You avoid the chances of having SEs from both surgery and radiation, in the event you need follow-up radiation after surgery.

Good luck to you--no matter what you choose you have every reason to think you'll do well!