PI-RADS score--2, Gleason 4+3 or 7 ?

That is a bit alarming, but if imaging could reliably see all cancer they wouldn’t need biopsy.

Based on PSA and your staging, you have a significant risk of Stage 3b with lymph node invasion. That’s why they put you on ADT now to shrink the area before treatment

Welcome to the Forum, PlatoK!

It's usually a good idea to get a 2nd opinion on the Gleason scores of the biopsy slides from an expert on urologic pathology such as Dr. J. Epstein at Johns Hopkins. At your request, your uro can usually have your slides sent directly to him.

MRIs are not perfect. In addition to interpretion errors by the reader, small lesions may not show up. On the flip side, we've even had several Forum Brothers whose PIRADS 4 and 5 lesions turned out not to be cancer. A positive biopsy, on the other hand, is diagnostic for PCa.

This underscores the importance of ensuring that a biopsy -- especially if it's an initial one -- is always a systematic with cores taken in all prostate zones, in addition to extra cores in any MRI-identified targets.

Extraprostatic extension (EPE) into or, more commonly through, the prostate capsule is often microscopic and may not be picked up by an MRI. In contrast, if a biopsy happened to hit EPE, IMO it is statistically likely to it being more pervasive than at a single small spot ("focal EPE"). But your docs can confirm or refute my hunch.

Keep us posted and good luck!

Djin

Thank you to everyone who answered so promptly. What a great service! No surgery, the MRI report was referring to the biopsy. I have a consultation with the radiation oncologist this Wednesday (June 2). My urologist suggested the possibility of TURP surgery but no prostatectomy I guess because of the PNI and EPE.

Where are you located? Some one on the board may have experience with specialists in your area.

Here is the his website. You'll see options for going through your doc or sending them yourself. I believe the review is covered by most insurers; if not, the out-of-pocket fee is a reasonable $300.

Djin

Pratoman said...
Plato welcome, not much to add, but here is the information to send your slides to Epsteins lab at Johns Hopkins...

http://pathology.jhu.edu/department/services/secondopinion.cfm

Very often, all you need to do is tell your doctor to have the slides sent to Jonathan Epstein (he doesnt do all the second opinions but he reviews them all and he is very accessible if you have questions after he's looked at them)

But if your Drs office isnt familiar, use the link above.

I think I remember a video interview in which Dr. Epstein said that he does all the reviews personally except when he is away from the office, e.g. for a conference. He added that if you want to be 100% he has reviewed your slides, include a note to that effect and he will review the report upon his return and add a comment whether he agrees with his colleague or not.

Plato,
If I would be you, I would be very suspicious of biopsy samples switched with some just done before you in other biopsy room. It happens that biopsy samples are not always labeled in front of the patient because docs are always rushed to next patient.
So big discrepancy between biopsy results and MRI puts big question mark to correctness of results. Something sometimes happened to your samples.
I would investigate it deeper before jumping on band wagon of serious radical treatment.
On this forum, I read about few patients who were rushed to RP surgery and after surgery, cancer was not present in their prostates at all.
I wish you good luck.
MK

As a follow up to MK’s point, you can also get a second opinion on your MRI. They can send or you can get the images on disk. My urologist was pretty specific who he wanted me to get my MRI from as he said he didn’t have good luck will some radiologists. Maybe try the University of Colorado for second opinion?

There are also different degrees of MRI based on the type of machine and methods used that can make big difference since the prostate is hard to visualize compared to a knee. That will be stated in the reports.

This information from all contributors is so appreciated. I definitely see how the wisdom of getting a second opinion/read on both the biopsy and MRI applies here. The radiation oncologist with whom I have an appointment tomorrow (Wednesday) is actually outside the Kaiser system in an adjacent cancer center (Good Samaritan in Lafayette, CO) though he works closely with Kaiser Urology. My plan now is to see what he has to say about the differential assessments of the MRI/biopsy and then move forward with seeking second opinions on both test results if indicated. I certainly don't mind paying $300 out-of-pocket for Dr. Epstein's review if this isn't covered by my current plan. (My annual rib-eye and Jack Daniels budget allocation is freed up since I have given up red meat and booze, at least until the smoke clears Again, I am much obliged to all who have taken the time to share their experience and advice.

On their website they disclose that they provide High Dose Rate brachytherapy and a variety of external beam therapies. All that is good as that would be an excellent combination method to pursue.

I saw the radiation oncologist today:

No brachytherapy due to enlarged prostate.
EBRT prep begins 8 June and the actual radiation (four weeks daily 5x per week) begins a couple weeks later. As many who responded to my initial post (Thanks!!!) indicated, my MRI was essentially inconsequential as regards treatment. Continue with Flomax and Finasteride add calcium (1000 daily) and vitamin D (ditto), avoid antioxidant supplements during radiation episode. Keep exercising (I swim, walk and do resistance machines at the gym 4-5X weekly). I can manage all that so...off we go!

Glad you have a plan in place. Make us proud!