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Opinion on MRI results

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Posted 1/25/2015 5:37 PM (GMT 0)
I am hoping someone can interpret the 3T MRI results
Prostate volume 38cc, central gland slightly enlarged consistent with BPH
5mm nodule in peripheral gland with diffusion restriction.
Rated as Intermediate
No ECE, neurovascular bundles & seminal vesicles are normal.
Lymph nodes ok.

Awaiting biopsy.
Is a 5mm nodule regarded as insignificant?
PSA
2011 5.6
2012 5.4
2013 5.9
2014 6.4, 8.1, 6.3, 8.2
Posted 1/25/2015 7:16 PM (GMT 0)
There's no standard definition of insignificant, but it's pretty insignificant in anyone's book, and is down near the limit of 3T MRI detection. It's not necessarily cancer, just a suspicious nodule. Only a biopsy can tell you that with certainty. On the whole, your report is good. Your PSA see-saw pattern is consistent with prostatitis, rather than PC. And you know you have BPH. In my non-professional opinion, those sources of PSA ought to be tackled first before jumping to an MRI and biopsy. But what's done is done, and now you have to follow it through.

- Allen
Posted 1/26/2015 6:39 PM (GMT 0)
Hi Allen,
Thanks for you reply.
I was surprised at the difference between two different MRI scans the previous one on a 1.5T MRI showed 3 areas of low signal and possible ECE in one area, whereas the 3T only shows 1 area and no ECE.
There was no inflammation visible on the 3T MRI.
Due to the nodule location (right peripheral at apex & midgland) I will be out for the biopsy ..due to having to bend the needle to reach the location. I presume this method of biopsy is sufficient as compared to template biopsy?
Is Gleeson score 7 and above mainly found in larger tumors
I appreciate your feedback.
Posted 1/26/2015 6:46 PM (GMT 0)
You get better resolution on the 3T - I'd go with that.

Rather than bend the needle, why can't they do it transperineal instead of transrectal?

Save the template saturation biopsy for at least a second biopsy, if warranted. That's a lot of holes.

GS 7 can be in small tumors too.
Posted 1/26/2015 8:57 PM (GMT 0)
I've seen a number of studies that suggest that adding a few oblique (bent needle) samples to a standard TRUS biopsy improves it's accuracy significantly, particularly for first biopsies.
Posted 1/26/2015 9:14 PM (GMT 0)
Transperineal was never mentioned ...I presumed that was used for a template biopsy only.
Does GS 7 only become relevant if a tumor is above a certain size?
Thanks Allen
Posted 1/26/2015 9:58 PM (GMT 0)
Hi Peter,
Thanks for the information ..that explains the logic behind it.
A 5mm nodule seems to be rated insignificant so I am trying to figure how it's rated intermediate on an mri.
Posted 1/26/2015 11:44 PM (GMT 0)
GS 7 puts one in the "intermediate risk" category independent of tumor volume. There is no risk category assigned until after a positive biopsy. A suspicious lesion on an MRI is not necessarily cancer.
Posted 1/27/2015 8:29 PM (GMT 0)
Thanks Allen,
I have not seen category/volume explained that way before.
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