PIRAD-5 MRI Results

Had a biopsy 3+ years ago because my PSA results kept elevating with the highest being around 5 (depending on which lab was used). But I still have blood in my semen. I've had two bladder cystoscopies and they showed no problems in the bladder.

Just had an MRI of my prostate this week with these results:

IMPRESSION
Findings consistent with neoplastic involvement of the right anterior
transitional zone at the level the mid gland, right posterior
peripheral zone at the level of the base as described.

Mildly prominent right internal and right common iliac lymph nodes.
These cannot be characterized further.

PIRADS 5

NARRATIVE

MRI PROSTATE WITH AND WITHOUT CONTRAST

HISTORY: Elevated PSA

TECHNIQUE: Multiparametric images of the prostate are obtained on a 3T
MRI. Dynamic contrast enhanced (DCE) imaging performed with 20cc
Dotarem IV contrast. 3D reconstructions were performed on independent
workstation.

FINDINGS:

Comparison: Prostate MRI July 10, 2021

Volume: 69 cc

Transition Zone Description: Inhomogeneous Signal Intensity. There is a
more localized area of confluent low T2 signal involving the right
anterior transitional zone at the level of the mid gland. This
demonstrates diffusion restriction. Findings are concerning for a
neoplastic process involving the right anterior and anterolateral
transitional zone at the level of the mid gland for which directed
biopsy is recommended.

Peripheral Zone Description: There is a 2.5 cm area of diffusion
restriction, reduced T2 signal intensity and mild hyperemia right
posterior peripheral zone at the base. Findings are consistent with a
neoplastic process, at least intermediate grade in appearance, for
which directed biopsy is again required.

No other discrete suspicious mass or diffusion restriction identified
in the peripheral zone.

Lesions: Right posterior peripheral zone at the base. Right anterior
transitional zone mid gland.

Seminal Vesicles: There is blood or proteinaceous fluid within a mildly
enlarged left seminal vesicle as compared to the right. No discrete
mass identified.
Nodal Disease: There are mildly enlarged right internal iliac and right
common iliac lymph nodes. These cannot be characterized further.
Neurovascular Bundles: Grossly intact.
Prostate Margin: Grossly intact.
Bones: No suspicious abnormal signal intensity identified.
Other Pelvic Organs: No mass lesion identified.

Most recent PSA is 4.7 but I am on Proscar which he says will suppress the number. Doc suggests another biopsy but using ultrasound (this is the doc at St Louis University that I went to for 2nd opinion). NOT thrilled about going through that again, as the biopsy I got 4 years ago darn near killed me when I went into septic shock the following day. That earlier biopsy of 20 cores which were all negative. But obviously have to check this out. Doc says maybe cancer, maybe not.

Anyone have experience on something like this? My previous threads are here:

https://www.healingwell.com/community/default.aspx?f=35&m=3985219

https://www.healingwell.com/community/default.aspx?f=35&m=4246284

Went and read the docs notes again. An MRI Fusion Biopsy is what is being recommended.

Good for you, putting yourself through that again.

As above, I would hope it will be transperineal. Again, worth checking. If it's some guy with a gun you know where squinting at a screen, run. In which case, you should have a pretty good idea of where you stand. It sounds like you've upgraded your uro: you want the best if you go the surgical route.

General comment: PCa suspects, it is time to turn our back on the 12-needle hit-and-hope merchants, with @IsItSerious here a pretty good illustration why. I never let them near me: changed uro as soon as it was suggested.

@Mumbo : knock you out if you're lucky... My 2nd was under local. In itself, fine but that local injection got my attention, I can tell you.

@IsItSerious : thinking about this a bit, PCa is not the only reason for RP. It's a big gland. (Do you have LUTS?) and whatever the cause (which, sorry, I think we can all agree might be PCa anyway), it's giving you grief. Whether it's a broken needle (does that happen: I'm just using my imagination), a drug-resistant infection or whatever, RP would at least save you a biopsy. And you're a young guy: with that gland, chances are you'll need intervention in an already-unhappy prostate at some point anyway. It has to be worth thinking about whipping it out.

Did the blood in the semen start after the biopsy or before? Back in 2017 I started getting blood in my semen. My uro said it was normal for my age. No PSA was taken. 6 months later, with blood still there, I asked to be referred to another uro. The uro said that it wasn’t normal and did a blood work up. My PSA was 4.6. He recommended a biospy which came back 3+3. I had some Urinating issues so he performed a TURP which fixed that issue and the blood. It was a watch and wait from there. My PSA has never been above 2. since then. My uro moved and my new uro said I should have been getting regular biopsies because of the past blood in my semen. My recent biopsy reflected a 4+4, which puts me at high risk. A contrast MRI and a contrast PET bone scan showed no problems. I am currently getting IMRT and on Orgovyx hormone therapy. Please be proactive, my low PSA hid the fact that I had high risk PC and blood in the semen is not normal. Wishing the best and hopefully your situation will turn out favorably. Jack