had mri and radiologist rating was rads4

Good morning and welcome to our club that none of us really wanted to join. Let's hope your biopsy is uneventful.

First, the good news: PiRads 4 means "there is something interesting", but it's not diagnostic. Also, your low PSA and negative DRE are good news as well. Even more good news: PCa (as we abbreviate it here) is generally slow growing, and even in it's most aggressive modes, it is manageable for many many years.

I also think a lot of doctors say things like you heard "you have a good chance of aggressive disease" without explaining what that means. I mean, really. Not good.

You've got a biopsy scheduled in a couple of weeks. That's good. It's not pleasant--in fact, it is a literal PITA. When it comes back, you'll have a lot more information, and we can help translate the terms for you. Here are a few things to start learning about:

Gleason Score: When a pathologist looks at your biopsy--they generally take at least 12 samples, often, as in your case with an MRI based target, they take a few more--they look at cell structures and give them a score from 1 to 5. In each core, they make two readings: Call them "Mostly" and "Some". So a Gleason score of 3+4 means that you have "Mostly" Gleason 3 pattern and "Some" Gleason 4 pattern, and then they are added to give a total of 7. Here is the confusing part: You'll never see a report of Gleason 1 and 2. Gleason 3 is the lowest grade to be considered cancerous, so Gleason 6 is the lowest grade for cancer.

As a general rule of thumb, it goes something like this:

Gleason 6: Low grade, low aggressiveness
Gleason 7: Low grade, low to medium aggressiveness
Gleason 8: Medium grade, medium to high aggressiveness
Gleason 9: High grade, high aggressiveness
Gleason 10: Really ugly (also quite rare)

The awesomely good news is that regardless of your score, modern treatments work really well. There are guys in this forum who have been living with, and living well with, Gleason 9 cancers for many years. No, the treatments aren't any fun--but they are manageable.

So, hang in there, come in and vent anytime. Let us know how your biopsy comes out. Also, sometime, let us know where you're located--we can steer you towards the best practitioners in your area, and maybe someone from here is nearby.

Thanks for your reply
Also I wish you well and hope all goes well for you

Post Edited (mr wine) : 10/10/2021 3:23:04 AM (GMT-6)

Anything is possible when interpreting imaging. I had a PI-RADS 4 & 5 lesion noted in my MRI and I could easily see the PI-RADS 5 in the imaging and the PI-RADS 4 was like looking at an ink blot test that only a radiologist could see.

PI-RADS 4 means there is enough that can be seen that makes the radiologist suspect something worth sampling. However, this says nothing about the cell structure so it can be benign or cancerous of some type, from mild to higher risk. Any imaging that shows suspicious lesions will note it as such and it is up to the doctor and patient to determine next steps.

There have been several occurrences of guys on this very website with PI-RADS 5 that had negative biopsies, so it's certainly possible that you will have a negative biopsy as well. All you can do at this point is continue to investigate. And the fact that the urologist has a place to aim for the biopsy (he should still do additional random samples) should help give you a more thorough biopsy than many of us here have had. I hope you get good news and that you're just passing through our parts...