MRI showed two lesions: Does this mean cancer?

My MRI showed a lesion, too. They said anything over 1cm is "a concern".
Doesn't necessarily mean cancer, but it's worth investigating further.
Mine was PI-RAD 4, I think.
I was booked in for a biopsy, which confirmed cancer.

Pirads 3 is iffy. May or may not mean anything. What you should realize is that people that have absolutely nothing found in their prostate during an MRI have been shown to have very serious prostate cancer after a biopsy. You can’t just rely on the MRI.

Your PSA isn’t too high, but your age range is just at the point where people start having prostate cancer pop up.

I personally would probably have the biopsy. Over 16 years ago when I had my first biopsy, the only thing they could go on was a slightly elevated PSA.

A PI-RADS 3 score means an intermediate risk for prostate cancer, also called a "gray zone," where the result is equivocal. It indicates that a radiologist is unsure if cancer or inflammation is present, and it is often managed with further investigation like a biopsy to get a definitive result.

What is your PSA Density, PSA Doubling Time, and % Free PSA? Those will help you determine which way to go.

If still unsure, I would get the MRI-guided biopsy. That’s the only way to know for sure,

@brianjarvis density .06 not sure of %free. PSA hovered around 4 + or - then 6.0 six weeks later 4.8

@yarddogman When PSA hovers between 4.0-10.0 (gray zone) and MRI doesn’t give a definitive answer (PIRADS 3) there are other biomarkers that may help in making the (very invasive) tissue biopsy decision:

PSA Density (PSAD): The larger the prostate volume (due to an enlarged prostate), the more PSA can be produced. PSA Density is the ratio of PSA to prostate volume. A PSAD above 0.15 (or 0.2 in some studies) can increase concern for prostate cancer, while lower values are more favorable.

% Free PSA: PSA circulates in the blood in two forms – either attached to certain blood proteins or unattached (“free”). If the PSA is elevated but the % Free PSA is low (< 25%), it may indicate a higher risk of prostate cancer.

PSA Doubling Time: The number of month it takes for PSA to double. If the PSADT is < 10
months, patients tend to do worse.

PSA Velocity: The change in PSA levels over time. A rapid rise in PSA may indicate the presence of cancer or an aggressive cancer.

Liquid biopsies: Some get a liquid biopsy first, and use those results to help make the decision whether to get a tissue biopsy,
> Liquid (blood) tests: 4KScore; EpiSwitch PSE; Phi Prostate Health Index;
FoundationOne®Liquid CDx.
> Liquid (urine) tests: SelectMDx; PCa3 (PC Antigen 3); MyProstateScore (MPS),
ExoDx.

In the meantime, you can still get another Total PSA test to compare it to your most recent one (and get the “Free PSA” test done with it so that you can calculate your % Free PSA).

If still unsure, I would get the MRI-guided tissue biopsy.

Your PSA has been 4-ish all along and then jumped to 4.8; that’s a pretty big jump. It could indicate an inflammation (prostatitis), or an infection…Why don’t you ask for an antibiotic and see if a follow up PSA 6 weeks later brings it back down to 4?
NOT diagnosing your problem, since some cancers can do this too; but a PIRADS 3 does give you some wiggle room to try other remedies first.
Phil

One layman opinion: Get the biopsy.

You have 2 identified "somethings" and the fusion guided biopsy will target them specifically (and also test generally within the prostate).

You can keep squinting through the dirty window, or open it up for a clear view.

Maybe they are benign; maybe not. I would have a good look because denial is not just a river in Egypt.

And I was cruising the Nile, praying that I didn't hit a sandbar.

My transrectal biopsy was a "none event" in July 2022, but identified Gleason 9 PCa, as well as a number of other positive findings including 8s & 7s. Sandbar!

Note: Transperineal biopsies are more available today and some men prefer them.

I waited a bit when my PSA first breached the magical "4" to 4.6 in 2000/2001 because I was wary of the "low PSA gerble wheel" of inconclusive biopsies (and COVID aided my procrastination). 5.6 drove me to the Urologist, and a subsequent 5.9 took me to an MRI followed by the Fusion Guided Biopsy.
My PSA breached 7 before my surgery in Aug 2022.

1 - Personal note: I will always regret not acting earlier, as my post-op pathology confirmed G 9 w/ EPE, my post-op PSA was .19 and salvage radiation treatment followed Feb - June 2023. Now < .02 uPSA 2 years post salvage treatment. And I will always wonder if the EPE could have been avoided.

2 - We know from patient experience on MCC that PSA is the canary in the coal mine, but that the bird can topple at PSA less than 4.

Again, I would have the biopsy. However, I understand totally the reluctance.

Best wishes on your choices.

I had a PSA of 4.8 and had an MRI with PIRADS 2 in 9/23. Continued to monitor. In 11/24 my PSA was 6.4 and a 1/25 MRI showed PIRADS 4 and possible metastases. Biopsy was Gleason 8. Now done with radiation and on hormone therapy. Made the correct calls along the way and still got nailed. In OP case I would get a biopsy.

I'm your same age, and just want to say that a biopsy is nothing to be particularly afraid of. In my case it was trans-rectal--many here feel trans-perineal is a better option--and it was really no big deal, and I drove myself home afterwards.
OTOH, P.C. is typically quite slow-moving, so waiting a month or two probably will not affect things much.
But I've seen a lot of borderline hysterical YT videos that warn people against getting prostate biopsies, and, like much on that platform, they are pure horse manure, so don't be overly-cautious. If you're inclined to get the procedure to elucidate your position, just go ahead!

In addition to tracking all the numbers like density, velocity, doubling time, potential benign characteristics, you could get another read of your MRI from Precision Prostate Consulting to confirm your Pirads 3.