Pirad 5 Biopsy tomorrow (summary of MRI)

Enlarged prostate with total glandular volume of 40.2 cc
Enlargement of central portion of gland representing 32% of glandular volume most commonly seen in BPH.
Suspicious lesion in right posterior medial / posterior lateral peripheral zone from the apex to the basal gland between the 6 and 9 oclock position. this lesion has a volume of 7.49 cc. and has a pirad score of 5.
the peripheral zones are noted for scattered non specific areas of decreased signal intensity most commonly seen with chronic prostatitis. (pirad 2)
The surgical capsule prostate is intact.
The seminal vesicles are normal.
There were no periprosthetic,peripelvic,obturator, or deep pelvic lymph nodes.
Th marrow signal is normal throughout the limited imaged portions of the bony pelvis.
My psa was 26 a month ago. This is all new to me and any thought would be appreciated.

Post Edited (weewillie131) : 7/6/2020 5:10:34 PM (GMT-6)

If the planned biopsy is targeted only (cores taken only in the MRI-identified lesions), I strongly suggest you tell you doc you want a targeted + systematic biopsy. The combination has a greater success rate of finding clinically significant cancer than either strategy alone. There have been forum guys whose PRIRADS 5 target turned out not to be cancer, but whose random cores hit serious lesions in another prostate zone.

Djin

As Sailor and Djin noted, the next step is a biopsy of the prostate and targeting the PIRADs 5 lesion noted in the MRI. The urologist should take a couple of extra cores in the area of the lesion, hopefully guided by the MRI. Then you wait for the call from the urologist with the biopsy pathology results. No way to speed up this part so you will have to wait for it to play out. Hopefully, they can get you in soon for the procedure but hard to know nowadays.

At face value, a high PSA and PIRADS 5 finding in the MRI requires further investigation as only a biopsy can obtain tissue samples to look at the cell structure and determine what is actually going on. It would be premature to get too excited when you don’t know what you are dealing with. However, we have all been there and it is a stressful period with your imagination working overtime. There are a number of books and publications that go over the entire prostate process if you want to start getting more info on the process you are now going through. The title below is one of the more well known books that you could search for but there are others.

Patrick-Walshs-Surviving-Prostate-Cancer

Not to confuse matters more for you, assuming your biopsy will be ultrasound guided like most are, your doctor should be able to direct the sampling cores to areas of interest in the 12 zones, looking for the lesion noted. The newer way is to use the MRI in conjunction with the ultrasound imaging to guide sampling towards observed lesions. Not all urologists use this technology but in theory, it should work better for finding cancerous cells.

In my case, 6 of 12 cores found enough cancer that I needed treatment and the 2 MRI guided cores at the lesions also found the worst case cancer grade in both locations which sealed my fate and the adventure began for real. Probably more detail than you need but you should ask your doctor about anything that concerns you at this point.

jmadrid said...
I had similar mpmri results but my psa was lower. I had three cores directed to the lesion and 5 random. The biopsy result was not so bad, a couple of G6 cores, though in different sides. Based in the bilateral involvement and the image results I decide to have surgery and my path report showed a prostate contained G5+3 lesion. This is my experience, everyone is different. Good luck.

The good news is that men who are confirmed pT2 N0 R0 after RP (prostate-confined plus negative margins) have a BCR rate of only 6-8%. In addition, Gleason score does not appear to be a risk factor, whereas some specific tumor-distribution patterns in the prostate are.

However, this best of post-RP path statuses cannot be guaranteed prior to surgery even with an encouraging biopsy, clinical workup, and imaging.

Djin

I'm glad all went well -- keep us posted and best of luck on the results, Willie!

Djin

Sounds like a good thorough sampling. Take it easy and don't stress the results too much! Fishing sounds perfect.