mri result. what does this mean...i see doc tomorrow

PiRad4 indicates a high likelihood of cancer. If you wait for it to get worse you may be depriving yourself of much less invasive treatments like TulsaPro or HIFU…
THE KITCHEN SINK IS NOT FUN!!
Talk to your urologist about a transperineal biopsy; aside from other advantages, it affords better access to all parts of the prostate; the transrectal does not.
You really want to know if this lesion is the only culprit; other areas may also have cancerous cells that are not coalesced enough to form a discernible image on MRI.
If everything else is normal, a single lesion is easily treatable with focal therapy and any side effects will be minimal.
Phil

At first I was going to get a biopsy upon the doctors recommendation but after extensive research on getting a biopsy I came across some seldom mentioned problems with getting a biopsy - things never mentioned in these threads or by urologists , possibly serious problems beyond the chances of infection , bleeding , pain etc. There are MANY cases of people with prostate cancer being spread that were thought to be low risk situations - and surprised the patients and doctors involved . The blame was put on " sub-microscopic " prostate cancer cells that were undetectable ..... These patients all had at least one biopsy . My worry was that , and others speculate the same possibility - that maybe the process of perforating the prostate with a needle over a dozen times could possibly be creating a " leak " of these submicroscopic prostate cancer cells and introducing them into other parts of the body ( bones , lymph nodes etc. ) .
This is what changed my mind on the biopsy , maybe punching holes in the prostate wall membrane ( if not absolutely necessary ) could be problematic .... maybe nature constructed the prostate wall in a way that prevents submicroscopic cancer cells from escaping ..... anyway , this was my logic in choosing to go with the MRI instead - I will be keeping a close eye on the situation and if things get more threatening as time progresses I will be quick to act .

At first I was going to get a biopsy upon the doctors recommendation but after extensive research on getting a biopsy I came across some seldom mentioned problems with getting a biopsy - things never mentioned in these threads or by urologists , possibly serious problems beyond the chances of infection , bleeding , pain etc. There are MANY cases of people with prostate cancer being spread that were thought to be low risk situations - and surprised the patients and doctors involved . The blame was put on " sub-microscopic " prostate cancer cells that were undetectable ..... These patients all had at least one biopsy . My worry was that , and others speculate the same possibility - that maybe the process of perforating the prostate with a needle over a dozen times could possibly be creating a " leak " of these submicroscopic prostate cancer cells and introducing them into other parts of the body ( bones , lymph nodes etc. ) .
This is what changed my mind on the biopsy , maybe punching holes in the prostate wall membrane ( if not absolutely necessary ) could be problematic .... maybe nature constructed the prostate wall in a way that prevents submicroscopic cancer cells from escaping ..... anyway , this was my logic in choosing to go with the MRI instead - I will be keeping a close eye on the situation and if things get more threatening as time progresses I will be quick to act .

I just wanted to give you a another perspective on your decision.

I am a retired Interventional Radiologist. Most people don't know what that is but for 40+ years I not only interpreted CTs, MRIs, PET scans, plain films etc, but I spent most of my time performing various procedures such as tumor ablations, kyphoplasty (repairing vertebral fractures), angioplasty, various other procedures and (relavent to this discussion) biopsies. Over the course of my career I biopsied thousands of lesions is virtually every organ of the body-including the prostate gland. There is no scientific evidence that needle biopsy seeds the tract or releases tumor cells in the body. It is difficult for cancer cells to grow outside their immediate environment. The vast majority of cancer cells that escape the primary tumor by lymph or vascular access die without their vascular supply and most are destroyed by the body's immune system. If a cancer cell was "pulled" out of the tumor and deposited along the needle tract, it would almost certainly die as it would have no immediate access to nutrients. The body is a hostile environment for foreign invaders or cancer cells outside of the primary tumor.

Here is a synopsis of my story. Of course, it is a sample of one so it may not apply to you. In 2019, as part of my routine physical exam, my PSA bumped up from around 4 to 5.6. Anything greater than a 20% year over year rise is concerning. I saw a urologist who did a digital exam and felt nothing. I had an MRI on our new 3T machine and it showed no enhancing lesions-essentially negative. I sent a blood sample to Mayo Clinic for fractionation and it was sent back "no fractionation performed as PSA < 4, normal for age". My urologist offered a biopsy but I declined and opted for a 6 month PSA followup. MY PSA declined into the 4 range 6 months later.
At my next annual physical my PSA had increased to 7.5. Back to the urologist who said let's repeat the MRI to see of there is anything new but I'm insisting on a biopsy no matter the results. The MRI showed a new enhancing nodule contained within the gland without evidence of spread. The biopsy revealed a high grade cancer, G8, at the site of the nodule.

I opted for a RP. Six months later my PSA went up to 0.37 and a PSMA PET revealed a solitary met at T8. I had successful SBRT (radiation) to that vertebral body that killed the met. Unfortunately, the next PSA 4 months later had increased to 4.6, rapid doubling. New PET revealed a new pelvic node (another met).

I consulted with a very experienced MO at JH and had immediate triple therapy followed by pelvic radiation. PSA went quickly undetectable and has thankfully stayed there for more than 2 years. Off all treatment meds now.

Medical decisions should be made on risk vs reward. You have an elevated PSA with a suspicious nodule in your prostate with a reasonable possibility it is a cancer. Enhancing nodules within the prostate (or other organs) have a good probability of being high grade tumor. The risk of a biopsy (in skilled hands) is fairly low. Your concern about releasing cancer cells is not scientifically proven. But if you do have a cancer there is a chance that it will continue to grow and possibly spread. It does not have to breach the capsule to spread by the vascular or lymph system.

In retrospect, I wish I had been more aggressive earlier and had a biopsy. It may have prevented the spread of cancer elsewhere.

Of course, any decisions related to biopsy or treatment are yours alone. But make this decisions based on facts. I wish you the best.

I just wanted to give you a another perspective on your decision.

I am a retired Interventional Radiologist. Most people don't know what that is but for 40+ years I not only interpreted CTs, MRIs, PET scans, plain films etc, but I spent most of my time performing various procedures such as tumor ablations, kyphoplasty (repairing vertebral fractures), angioplasty, various other procedures and (relavent to this discussion) biopsies. Over the course of my career I biopsied thousands of lesions is virtually every organ of the body-including the prostate gland. There is no scientific evidence that needle biopsy seeds the tract or releases tumor cells in the body. It is difficult for cancer cells to grow outside their immediate environment. The vast majority of cancer cells that escape the primary tumor by lymph or vascular access die without their vascular supply and most are destroyed by the body's immune system. If a cancer cell was "pulled" out of the tumor and deposited along the needle tract, it would almost certainly die as it would have no immediate access to nutrients. The body is a hostile environment for foreign invaders or cancer cells outside of the primary tumor.

Here is a synopsis of my story. Of course, it is a sample of one so it may not apply to you. In 2019, as part of my routine physical exam, my PSA bumped up from around 4 to 5.6. Anything greater than a 20% year over year rise is concerning. I saw a urologist who did a digital exam and felt nothing. I had an MRI on our new 3T machine and it showed no enhancing lesions-essentially negative. I sent a blood sample to Mayo Clinic for fractionation and it was sent back "no fractionation performed as PSA < 4, normal for age". My urologist offered a biopsy but I declined and opted for a 6 month PSA followup. MY PSA declined into the 4 range 6 months later.
At my next annual physical my PSA had increased to 7.5. Back to the urologist who said let's repeat the MRI to see of there is anything new but I'm insisting on a biopsy no matter the results. The MRI showed a new enhancing nodule contained within the gland without evidence of spread. The biopsy revealed a high grade cancer, G8, at the site of the nodule.

I opted for a RP. Six months later my PSA went up to 0.37 and a PSMA PET revealed a solitary met at T8. I had successful SBRT (radiation) to that vertebral body that killed the met. Unfortunately, the next PSA 4 months later had increased to 4.6, rapid doubling. New PET revealed a new pelvic node (another met).

I consulted with a very experienced MO at JH and had immediate triple therapy followed by pelvic radiation. PSA went quickly undetectable and has thankfully stayed there for more than 2 years. Off all treatment meds now.

Medical decisions should be made on risk vs reward. You have an elevated PSA with a suspicious nodule in your prostate with a reasonable possibility it is a cancer. Enhancing nodules within the prostate (or other organs) have a good probability of being high grade tumor. The risk of a biopsy (in skilled hands) is fairly low. Your concern about releasing cancer cells is not scientifically proven. But if you do have a cancer there is a chance that it will continue to grow and possibly spread. It does not have to breach the capsule to spread by the vascular or lymph system.

In retrospect, I wish I had been more aggressive earlier and had a biopsy. It may have prevented the spread of cancer elsewhere.

Of course, any decisions related to biopsy or treatment are yours alone. But make this decisions based on facts. I wish you the best.