Pi-Rads 4 indicates a high likelihood of prostate cancer. The lesion size is big enough to warrant a biopsy for sure. I wouldn't freak out about this, talk to your doctor first and he might want to follow up with a biopsy to see if it's worth addressing (if he does, ask for a Decipher as well).
Many prostate cancers don't need treated as they are very slow growing, just because you have it doesn't mean you are in for trouble. The saying that always goes around for many men: more likely to die WITH prostate cancer than FROM it.
Pi-Rads 4 indicates a high likelihood of prostate cancer. The lesion size is big enough to warrant a biopsy for sure. I wouldn't freak out about this, talk to your doctor first and he might want to follow up with a biopsy to see if it's worth addressing (if he does, ask for a Decipher as well).
Many prostate cancers don't need treated as they are very slow growing, just because you have it doesn't mean you are in for trouble. The saying that always goes around for many men: more likely to die WITH prostate cancer than FROM it.
I went straight to Dr Google.
He said:
"PI-RADS 4 lesions are considered to have a “high” likelihood of clinically-significant prostate cancer.
The higher the PI-RADS score, the greater the likelihood of prostate cancer.
PI-RADS 3 carries about a 12% risk of clinically significant cancers, PI-RADS 4 about 60%, and PI-RADS 5 about 85%."
60% is not 100%
But it does indicate that you may need to mentally prepare for a cancer diagnosis.
My MRI said "a PI-RADS 4 lesion in the right apex, quite significant on the B2000 imaging." (whatever that means).
The big thing is the follow-up biopsy - where they take pieces of the prostate & throw them under a microscope.
Only then can they say definitively that you "have cancer" and make aa good guess on how far it may have spread - if at all.
So your next step is the biopsy - something most of us have gone through & are happy to provide reviews on the experience.
Keep us updated. At PI-RADS4, it's not necessarily all doom & gloom.
Is it trans perineal or rectal? Greater access is afforded by the perineal approach and more samples can be taken of areas that did not necessarily show up on the MRI.
I also had a Pi-Rads 4 mass identified in my prostate after a HOLEP. I will get a biopsy on March 12th. My Gleason is 3+4 so it is not tooooooo bad. I am leery of radiation, and am going to look into HIFU or laser ablation instead. Please let me know the results of your biopsy and what treatment you will do if any.
I was also Pi-Rads 4, Gleason 7, Decipher 0.68. Once removed I was upgraded from stage II to stage III.
I have no incontinence - not even a single drop, I have no erectile dysfunction and am basically as I was two weeks ago (prior to surgery).
This is to say that positive outcomes are possible. I worked for months hammering my pelvic floor through exercise and kegels, dropped 25lb and gained back 10 in muscle. I started working the problem the instant I found out and between that and an excellent surgeon I'm on the other side of it relatively intact.
I let myself get into a deep gloom over my diagnosis but still worked it hard. Part of the reason is that forums like this, inherently, don't have a lot of great news - most guys sticking around have issues or are like you and have questions - few of the success stories stick around but I'm trying to be the guy that does so that the next poor guy that has to go through all of this at least can see that it's not all bad.
I was also Pi-Rads 4, 1.3 cm, Gleason 7 (4+3). I chose Tulsa Pro at Mayo Rochester in July 2024. At 6 months there is no sign of cancer. I liked the technology and precision of Tulsa & the low risk of side effects. Also, all other treatment options are still on the table if cancer returns.
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Pi-Rads 4 indicates a high likelihood of prostate cancer. The lesion size is big enough to warrant a biopsy for sure. I wouldn't freak out about this, talk to your doctor first and he might want to follow up with a biopsy to see if it's worth addressing (if he does, ask for a Decipher as well).
Many prostate cancers don't need treated as they are very slow growing, just because you have it doesn't mean you are in for trouble. The saying that always goes around for many men: more likely to die WITH prostate cancer than FROM it.
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4 Reactionsthanks! I have been freaking out. I have a biopsy set foe 2/24 thx again!
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3 ReactionsFYI- had my biopsy 2/2/2022. 13 biopsys-Gleason 8/9/10. I m still here today 2/13/2025. RT and ADT did the trick. PSA < .01 Hope this relaxes ya- lol
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8 ReactionsI had a PI-RADS4, too.
I went straight to Dr Google.
He said:
"PI-RADS 4 lesions are considered to have a “high” likelihood of clinically-significant prostate cancer.
The higher the PI-RADS score, the greater the likelihood of prostate cancer.
PI-RADS 3 carries about a 12% risk of clinically significant cancers, PI-RADS 4 about 60%, and PI-RADS 5 about 85%."
60% is not 100%
But it does indicate that you may need to mentally prepare for a cancer diagnosis.
My MRI said "a PI-RADS 4 lesion in the right apex, quite significant on the B2000 imaging." (whatever that means).
The big thing is the follow-up biopsy - where they take pieces of the prostate & throw them under a microscope.
Only then can they say definitively that you "have cancer" and make aa good guess on how far it may have spread - if at all.
So your next step is the biopsy - something most of us have gone through & are happy to provide reviews on the experience.
Keep us updated. At PI-RADS4, it's not necessarily all doom & gloom.
-
Like -
Helpful -
Hug
3 ReactionsIs it trans perineal or rectal? Greater access is afforded by the perineal approach and more samples can be taken of areas that did not necessarily show up on the MRI.
I also had a Pi-Rads 4 mass identified in my prostate after a HOLEP. I will get a biopsy on March 12th. My Gleason is 3+4 so it is not tooooooo bad. I am leery of radiation, and am going to look into HIFU or laser ablation instead. Please let me know the results of your biopsy and what treatment you will do if any.
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Helpful -
Hug
2 Reactionsthanks!
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1 ReactionI was also Pi-Rads 4, Gleason 7, Decipher 0.68. Once removed I was upgraded from stage II to stage III.
I have no incontinence - not even a single drop, I have no erectile dysfunction and am basically as I was two weeks ago (prior to surgery).
This is to say that positive outcomes are possible. I worked for months hammering my pelvic floor through exercise and kegels, dropped 25lb and gained back 10 in muscle. I started working the problem the instant I found out and between that and an excellent surgeon I'm on the other side of it relatively intact.
I let myself get into a deep gloom over my diagnosis but still worked it hard. Part of the reason is that forums like this, inherently, don't have a lot of great news - most guys sticking around have issues or are like you and have questions - few of the success stories stick around but I'm trying to be the guy that does so that the next poor guy that has to go through all of this at least can see that it's not all bad.
We are behind you!
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4 Reactionsthat was wonderful!! thanks!
I was also Pi-Rads 4, 1.3 cm, Gleason 7 (4+3). I chose Tulsa Pro at Mayo Rochester in July 2024. At 6 months there is no sign of cancer. I liked the technology and precision of Tulsa & the low risk of side effects. Also, all other treatment options are still on the table if cancer returns.
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3 Reactions