How concerning is this PSA rise?

By luck (a canceled appointment and treating the scheduler with the respect she deserves), I was able to have my mri rescheduled to tomorrow. I will let you know how it goes.

Here is the mri report, am waiting for doctor to contact me to discuss. Please comment if you would like.

Impression
1) Findings suggestive, but not definite, for prostate cancer (score = 3/5). (1 = normal; 5 = highly suspicious).
2) No evidence of extracapsular extension. No evidence of seminal vesicle invasion.
3) Enlarged right internal iliac chain lymph node. No aggressive osseous lesion.
Narrative
Exam: MRI of the Male Pelvis without and with Contrast

History: Elevated prostate specific antigen

Technique: Breath-hold and non-breath-hold multiplanar assessment of the male pelvis was undertaken using external body surface coils to assess extraprostatic disease and stage the pelvis. T1, T2, gradient echo, and steady state images were created, with and/or without fat suppression, per standardized protocol to assess tissue characteristics. These included screening images to assess the abdominal retroperitoneum and regional osseous anatomy for metastatic disease. Multiparametric assessment of the prostate was undertaken with the application of multiplanar T2, diffusion, and dynamic perfusion series in an attempt to characterize intraprostatic disease distribution and volume. Image fusion analysis and semi-quantitative review was conducted using Dyna-CAD prostate imaging analysis software.

IV contrast: 8 mL of Gadovist.

Comparison: None.

FINDINGS:
Prostate volume: 90.1 cc

PSA: 9.8 ng/mL.

PSA density: 0.01

Multiparametric MR evaluation:
Heterogeneous appearance of the central and transition zone, compatible with benign prostatic hyperplasia.

Lesion 1:
Right lateral peripheral zone in the mid gland. Lesion measures 1.4 x 0.6 x 1 cm with a volume of 0.64 cc.

On T2-weighted MR imaging, the lesion is seen as a well-defined focus of low signal intensity (score = 4/5).

The lesion demonstrates mild restricted diffusion (score = 3/5).

No suspicious enhancement identified.

Overall score = 3

Capsular margin and neurovascular bundle: No evidence of macroscopic extracapsular extension.

Seminal vesicles: No evidence of seminal vesicle invasion.

Lymph nodes: Enlarged right internal iliac chain lymph node best seen at series 12, image 5 measuring 1.2 cm in short axis

Bones: No aggressive lesion.

Urinary bladder: Mildly thickened, possibly related to chronic outlet obstruction.

Colon and rectum: Unremarkable.

Other: None.

I had a colleague who had an increasing PSA and they kept doing biopsy's that came up negative. The doctor decided to go in the other direction and found the cancer on one side of the prostate. The side you couldn't get to from traditional biopsy. Everyone is different... be your own advocate.

Well, nothing in here says you definitely have cancer. They’re probably going to want to do a biopsy.

A PSMA Pet test might make sense now, it can see if there is any cancer in your body unless it is very small, and that wouldn’t be caught on an MRI either.

A PSE test might be useful in this situation, To maybe be avoid the biopsy because it can tell you if you have cancer. The PSMA pet test might be more useful, however.

Had the mri, as you can see from my previous post. Prostate is now 90cc and is having an effect on my peeing. Very hard to get everything out of the bladder.

I read the MRI, the lesion doesn’t appear to definitely be cancer because there are no PI-RADS listed, Did someone tell you otherwise?. It could be a Gleason six, not cancer. That’s why I mentioned the PSE Test to see if you truly had cancer. And the PSMA pet can see cancer more specifically than an MRI.

Have you spoken to the doctor? It would be interesting to hear what he has to say.

Are you being treated at a center of excellence?

No one has told me anything yet. Haven't seen the doctor. You mention pi rad scores, would those be the two listed as Score 4/5, Score 3/5 and Overall Score 3? You can see what I mean below. Thanks

Multiparametric MR evaluation:
Heterogeneous appearance of the central and transition zone, compatible with benign prostatic hyperplasia.

Lesion 1:
Right lateral peripheral zone in the mid gland. Lesion measures 1.4 x 0.6 x 1 cm with a volume of 0.64 cc.

On T2-weighted MR imaging, the lesion is seen as a well-defined focus of low signal intensity (score = 4/5).

The lesion demonstrates mild restricted diffusion (score = 3/5).

No suspicious enhancement identified.

Overall score = 3

The T2 weighted image is what's important in discerning things. That image indicates a 4/5 which means in my understand a lesion with a PIRAD-4 rating. There is definitely something there, probably not advanced yet to PIRAD-5. You have a 90 cc prostate which is large, hence BPH and difficulty urinating. Mine was 100cc, so I understand your concern. A prostate of 90cc might yield a PSA in the range of 9. A rough rule of thumb is prostate volume divided by 10...........but I'm sure that varies somewhat. Although I'm not a doctor, my read on this is you've most likely caught this early, which to me means you have some time. I took from March to October to navigate this process. You may want to get a second opinion of the read of your MRI to make sure you have consistent, reliable information. Interpretation of these images depends heavily on the radiologist reading it. Find a center of excellence to give you a second opinion you know you can trust. You need the best reliable information in order to chart a good decision for you. I believe you have time. Get a fusion biopsy, so that you have the highest probability of targeting the lesion. Get a second opinion on the biopsy core samples as this is also critical to deciding on a course of action. Johns Hopkins has a website. They are a center of excellence for such readings. It's only a couple hundred dollars for the read and insurance paid for mine. Well worth it if you have to pay for it yourself. Get a Decipher or Oncotype dx test done on your biopsy samples to assess aggressiveness of the cancer if it's determined that you have cancer. Get yourself educated. You're going to be the one making the final decisions. I found tremendously useful the website pcri.org. There's a wealth of information there by a medical oncologist who spent his entire career on prostate cancer. Extremely well done and current information. I urge you to take a look. Hope this is helpful.