PSA 8.6, MRI PIRADS 5, Biopsy scheduled, so a bit worried

I have not read all the comments so my question may have been addressed earlier. Did you mri and biopsy show that the cancer is contained within the prostate or is there extraprostatic extention? This could be a factor in your treatment choice. If there is extraprostatic extension I would definitely have a psma pet scan before making a choice. I was 4+3=7 with very minor extraprostatic extension and chose RP. My six week post psa test was higher than before surgery. PSMA pet showed my entire pelvic bowl was clear but it had jumped to my abdominal and chest lymph nodes. I probably would have made a difference choice if I had this info prior. Knowledge is power.

Based on MRI/Biopsy, all cancer is contained within the prostate.

See you just joined our support group….hopefully you’ll find it a place where you can share your concerns and find folks who have similar experiences and develop questions that you can take back to your doctor(s).

Please recognize that nothing I (or anyone in this group) write should be considered medical advice…we share our experiences with prostate cancer in hopes that it will encourage and elicit questions that others can direct to their physician(s).

First, let me congratulate you on your weight loss, assuming you had some excess to shed, that’s a significant feat!

The post, that you reference, is ~14 months old, so I went back to refresh my memory.

Much has transpired since that post…my Decipher score came in at 0.22 (low risk), so I embarked on a recommended active surveillance program.

My PSA levels (I’ve had 6 tests since then) have averaged 6.2, as compared to 7.8 prebiopsy.

More importantly, I’ve had a 12 month follow up mpMRI which showed the PIRADS 3 and 4 lesions were not visible and the PIRADS 5 lesion had weakened signaling.

In any case, I continue my AS program and I’ve maintained my lower weight (a drop of 25 lbs in first three months after diagnosis) for over a year.

I have changed various aspects of my diet; and now it’s quite diverse.

IMHO, based on all the research I’ve done I believe my cardio exercise (running) regiment is more important than diet when it comes to slowing the progression of PCa….but again…that’s just me….results may vary…

I understand your concerns about biopsy…you can review my related post, for specifics, under discussions in my profile. However, I don’t think my biopsy experience was typical of what the vast majority apparently experience.

I think you are right in asking for a mpMRI PRIOR to submitting to a biopsy…from what I’ve read that’s “standard of care” protocol by the vast majority in the field…and it’s critically important if you end up pursuing AS.

All the best!

Alan

Not sure how to proceed with a result like this. Confusing. No clear direction from my doctor…..

HISTORY: Prostate specific antigen above reference range R97.20: Elevated prostate specific antigen (PSA)

COMPARISON: None.

TECHNIQUE: Multiplanar multisequence MR imaging of the pelvis performed without and with intravenous contrast using the prostate protocol. Multiple B-value diffusion-weighted imaging in the axial plane was also performed through the prostate gland with
ADC mapping.

IV Gadavist 10 mL.

FINDINGS:

PROSTATE VOLUME: 6.8 x 4.29 x 6.1 cm with a prostate volume 95 mL.

PERIPHERAL ZONE: Diffuse abnormality of the peripheral zone noted characterized by low T2-weighted signal and mildly elevated diffusion-weighted signal and mildly decreased ADC signal without focal lesions. The capsule is well defined.

TRANSITION/CENTRAL ZONE: Diffuse nodular transition zone noted

OTHER PELVIS: No pelvic adenopathy identified. The seminal vesicles appear symmetric. The bladder appears normal.
Impression
IMPRESSION:

1. Diffuse abnormality the peripheral zone. This is a nonspecific finding and can be seen in both acute and chronic prostatitis or other inflammatory process and rarely in diffuse malignancy. Malignancy being considered less likely in the presence of
a well-defined capsule. Consider follow-up MRI in 6 months.

FINAL PI-RADS: 3, intermediate. The presence of clinically significant cancer is equivocal.

Your initial question indicated that a PIRADS 5 lesion was found, but I didn’t see that mentioned in the MRI report you posted.

Was a PIRADS 5 mentioned elsewhere…there’s a significant difference between a PIRADS 3 and a PIRADS 5.

Why are you saying: “No clear direction from my doctor…..”?

I would also be asking:

1) About the possibility of prostatitis?
2) What has been your PSA trend…has your 8.6 been stable, recently rising, or brand new….prior PSA values matter.
3) What is your family history of prostate cancer?
4) Have you had a digital rectal exam (DRE), if so what was the result?

More questions to ask your doctor….

Best,

Alan

It is a PIRADS 3. The radiologist said come back in 6 mos for another MRI. Just seems like a long time to wait with family history of prostate cancer and my elevated PSA tests (8.1 and 7.8). And I haven’t known my doctor very long so it’s hard to know what he truly thinks. But the interpretation of the MRI could be a more benign condition. Appreciate your response.

Thanks for clarifying.

PI-RADS 3 means the findings are neither clearly benign nor obviously malignant (equivocal).

Also, the lack of focal lesions and a well-defined capsule makes a diffuse malignancy less likely. Prostatitis (inflammation) or other non-cancerous conditions could also explain these findings. I’d recommend watching Dr. Mark Emberton’s presentation on “MRI-invisible lesions and low risk prostate cancer”…it was incredibly useful for me.

One thing I learned when studying the effects of exercise on slowing PCa progression is that weight reduction can also cause PSA to decrease. Therefore, you might want to have your PSA retested, if you have not already done so since losing 20 lbs.

Finally, I found that by inputting all my test data (including my MRI report), as provided in its original form, into Grok3, I was able to get a layman’s explanation of its meaning which was quite useful in explaining things that were confusing to me. It’s not a substitute for your doctor, but it can help clarify obtuse medical language and seemingly conflicting test results and statements.

All the best,

Alan

Appreciate that. I will definitely watch the presentation.
I lost my 20lbs after my high PSA tests and a complete change in my diet. I also stopped drinking beer and wine. I think I’ve had an enlarged prostate for some time. What is Grok3? And I think I’ll ask my doctor to order another PSA before the 6 month MRI. It might still be elevated due to my enlarged prostate but if it’s not increasing it will give me some peace of mind. I never enjoyed running when I was younger, not sure if I do now, but it feels sort of empowering and satisfying.

Grok3 is the latest AI engine. About year ago I began using ChatGPT, then perplexity.ai and OpenEvidence.com…. Grok3 is AI on steroids…I use it to ask about everything….it’s absolutely incredible. The future is here….for the rest of us….

Regarding running: that’s just me….my first time out on the track was July 1, 2022…I weighed almost 195 lbs and could only slow jog once around the track before I had to walk a lap, which I could only repeat 3X.

I worked my way up to running 3 - 5K’s per week; however, I now think I was mainly running too fast (a lot of anaerobic heart rate); although I did manage to reduce and maintain to 160 lbs, for the last year.

Recently, I’ve slowed down to Zone 2 running (70% of my max heart rate); which I do for a 10K, 3X/week. This keeps my heart and lungs in full aerobic condition the entire time….sustainable running (and more comfortable).

Even so, running isn’t required…my younger brother (your age) uses an elliptical, since he has hamstring issues.

The important thing is to work up to getting your heart rate into your Zone 2 aerobic zone for at least an hour, 3x per week.

If you aren’t exercising currently, give yourself plenty of time to work up to that goal….most folks should be able to achieve the “hour in their aerobic zone” in a couple months with regular exercise.

You’ll be amazed at the results, which extend well beyond dealing with prostate issues.

I have read Dr. Peter Attia’s book, “Outlive”…twice…it’s an amazing work of how most of the current medical establishment (Medicine 2.0) has pretty much failed to adequately address the long term effects of the chronic horseman (dementia, diabetes, heart disease and cancer) and he provides actionable information, based on scientifically determined results, regarding what he calls Medicine 3.0…focused on preventive, patient controllable lifestyle issues.

Btw: I enjoy a 7 ounce glass of red wine every day 😉

All the best,

Alan

I’ve been running every other day since mid January. Up to about 4.5 miles around a track. About 40 minutes. With change in diet went from 227lbs to 206. I’m 6’0 and it feels good although a new look. The other days I ride an incumbent and do some weights, planking, etc. I haven’t had a PSA since weight loss but it’s probably still elevated. I enjoy wine too. Even make my own Pinot and Cab but for now just taking a break until I get some more info about my prostate condition. I’ll check that book out. Thanks.