1. < Prostate Cancer

MRI Results and Next Steps??

Posted by nsdq60 @nsdq60, 6 days ago

I've been under surveillance since diagnosed with PC in 2021 and last month my PSA jump from 4.26 to 9.1. It's been a week and I haven't heard from my Urologist, so assuming another biopsy is the next step(s)?

Examination: MRI of the pelvis without and with contrast-prostate
Technique: MRI of the pelvis was obtained before and after the
uneventful administration of gadolinium based contrast according
to the prostate protocol
History: Elevated PSA
Comparison: None available
Findings: The prostate gland measures 4 x 3.5 x 4.4 cm.
ROI 1: There is a left apex peripheral gland moderately T2
hypointense moderately diffusion restricting 0.8 x 0.7 cm nodule
on series 4, image 26
The capsule is intact. Seminal vesicles are clear. The
neurovascular bundles are preserved. Fascial planes are thin. No
enlarged lymph nodes are seen. No suspicious osseous lesions are
demonstrated.
Visualized portions of the large and small bowel, urinary
bladder, and abdominal vasculature are normal.
Impression: ROI 1: PI-RADS - 4

Any recommendations and perspectives are appreciated!

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happydappy | @happydappy | 6 days ago

A PI-RADS 4 lesion is usually recommended for a biopsy. That was my experience with two different MRIs and lesions. Make sure it's a MRI fusion guided biopsy that targets the lesion. And most combine targeted cores with random cores to sample all over the prostate. I've had both trans rectal and trans perineal biopsies and recommended the later as they say it provides better access to the entire prostate.

REPLY
1 reply
peterj116 | @peterj116 | 6 days ago

I had a PI-RADS 4.
60% chance of clinically-significant cancer.
Next step is a biopsy, to get samples.

Nag them. Now is not the time to be quiet & worry about "bothering them".

A week is a long time to worry, but as you'll soon find out, the waiting is the hardest part.
You're on track for a biopsy & it may take time - but it doesn't hurt to ask for a time frame.

Good luck.

REPLY
1 reply
nsdq60 | @nsdq60 | 6 days ago
In reply to @happydappy "A PI-RADS 4 lesion is usually recommended for a biopsy. That was my experience with two..." + (show)
@happydappy

A PI-RADS 4 lesion is usually recommended for a biopsy. That was my experience with two different MRIs and lesions. Make sure it's a MRI fusion guided biopsy that targets the lesion. And most combine targeted cores with random cores to sample all over the prostate. I've had both trans rectal and trans perineal biopsies and recommended the later as they say it provides better access to the entire prostate.

Jump to this post

Thanks so much for this information. I've had a total of three biopsies so far and was not aware of the two different types (trans rectal & trans perineal).

REPLY
1 reply
nsdq60 | @nsdq60 | 6 days ago
In reply to @peterj116 "I had a PI-RADS 4. 60% chance of clinically-significant cancer. Next step is a biopsy, to..." + (show)
@peterj116

I had a PI-RADS 4.
60% chance of clinically-significant cancer.
Next step is a biopsy, to get samples.

Nag them. Now is not the time to be quiet & worry about "bothering them".

A week is a long time to worry, but as you'll soon find out, the waiting is the hardest part.
You're on track for a biopsy & it may take time - but it doesn't hurt to ask for a time frame.

Good luck.

Jump to this post

Thanks for this information and guidance! I'll inquire with my Urologist tomorrow.

REPLY
peterj116 | @peterj116 | 6 days ago
In reply to @nsdq60 "Thanks so much for this information. I've had a total of three biopsies so far and..." + (show)
@nsdq60

Thanks so much for this information. I've had a total of three biopsies so far and was not aware of the two different types (trans rectal & trans perineal).

Jump to this post

There are good animations of the 2 procedures here


and here
https://www.youtube.com/watch?v=pevP48PzRgU&t=20s (from 4:47)

It's helpful to watch these so you're aware of what's happening "down there" where you can't see.

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davidog | @davidog | 6 days ago

69 yrs on planet. My 8 year younger sibling had a prostatectomy 3 years ago. My annual PSA went to 4.0 last December. PCP referred me to Urologist. 4K blood test 51.3, “elevated risk” category. He ordered MRI. 2 PI-RADS 4 lesions. Today had a transperineal MRI/ultrasound fusion-guided biopsy (but not the robot-guided kind). Now awaiting results. I have no blood in my urine, fairly easy to pee. Notable bruises on either side of the little needle marks on the perineum (which one of the care team advised me might be the case). Another friend here with PI-RADS 4 opted for the Artemis (robot) fusion biopsy (trans-rectal) and had good experiences with 2 procedures. I opted to go with my guy for the slightly better odds of no infection. I had a hip replacement in January and want to minimize infection possibilities. May your biopsy be illuminating and encouraging!

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michaelcharles | @michaelcharles | 5 days ago

I would have anticipated communication with my Urologist or the office and a repeat PSA to verify increase, as well as a plan for a MRI guided biopsy.

Best wishes.

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