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Not Good News after prostate biospy when MRI didn't look too bad
Last month I had PSA of 5.23 when a few months earlier it was 3.2. Then they scheduled me for MRI of prostate. Did another PSA and it was down to 4.16, but still wanted the MRI. Report is below, doesn't look good PI-RADS 5. At one point they say in report Lesions (PI-RADS 3 or higher). If I understand it, it hasn't spread. Wish I could get a plan with doctor!
FINDINGS:
Prostate measurement: 5.7 x 5.0 x 4.9 cm Prostate volume: 68.75 cc PSA: 4.16 ng/mL PSA density: 0.06 ng/mL/cc
Peripheral zone: See below.
Transition zone: No index lesion. Stromal and glandular BPH nodules.
Lesions (PI-RADS 3 or higher):
Lesion # 1: Location: Left posterior peripheral zone extending from the base to the apex Size: 2.4 x 1.3 x 2.6 cm (5.83 cc). T2: T2
hypointense DWI: Marked restricted diffusion DCE: Focal early enhancement, positive Prostate margin: Abuts the capsule without
definite invasion Overall PI-RADS Score: 5/5
Prostatic capsule: Intact.
Neurovascular bundles: Not involved.
Seminal vesicles: Not involved.
Lymph nodes: No lymphadenopathy.
Bones: No acute osseous abnormality.
Other findings: Small fat-containing right inguinal hernia.
IMPRESSION:
1. The prostate gland measures 5.7 x 5.0 x 4.9 cm with volume of 68.75 cc. PSA density is 0.06 NG/mL/CC. 2. Lesion # 1: PI-
RADS 5 lesion in the left posterior peripheral zone extending from the base to the apex measures 5.83 cc. No frank extracapsular
extension. 3. No pelvic lymphadenopathy.
PI-RADS Category 5: Very high (clinically significant prostate cancer is highly likely to be present)
Really doesn't look to bad, one spot that hasn't spread!
Then Bad Update 2/10/2026
Well got biopsy yesterday and results today, doctor hasn't called, just sent biopsy results to MyChart.
The MRI showed only one Lesion like shown above. Had biopsy done yesterday, they did 3 from the Lesion and 6 from each side of prostate. I wondered why they did more biopsy that were outside the lesion, but didn't ask. Got report today- not good. The lesion look better than areas where MRI saw nothing. They took 15 samples total.
Results:
Final Diagnosis
View trends
A. Prostate, "LLB", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 30% of needle core tissue.
B. Prostate, "LMB", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 70% of needle core tissue
C. Prostate, "LLM", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 60% of needle core tissue.
D. Prostate, "LMM", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 60% of needle core tissue.
Large cribriform glands present.
E. Prostate, "LLA", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 60% of needle core tissue.
F. Prostate, "LMA", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 50% of needle core tissue.
G. Prostate, "RLB", biopsy:
Benign prostatic tissue.
H. Prostate, "RMB", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 10% of needle core tissue.
I. Prostate, "RLM", biopsy:
Benign prostatic tissue.
J. Prostate, "RMM", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 50% of needle core tissue
Large cribriform glands present.
K. Prostate, "RLA", biopsy:
Benign prostatic tissue.
L. Prostate, "RMA", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 25% of needle core tissue
M. Prostate, "ROI#1", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 3 of 3 cores involving 70% of needle core tissue
Another thread I posted in a person said "You have a Gleason 4+3 7 BUT you have large cribriform and doctors a UCSF say that puts a 5 in your Gleason score." I believe he picked this up from the biopsy report. I don't know what a cribriform even is, it's not mention in report. From googling around it can only be determined by sieve-like or "Swiss cheese" appearance under a microscope and I don't see that in report? But this is all new to me. Doctors haven't talked to me yet, who knows when they will call or make appointment, took long time to get MRI and even longer to get the biopsy done. Sure were fast getting results, they said 7 - 10 days and they gave them to me the next day. Kind of wish they didn't give me results prior to talking with me.
My first thought is just get the thing cut out, not sure how that is done, as seems they got to leave something in there for urine to flow threw. So they couldn't take 100 percent of prostate out. Then I read about nerve sparing or not and not sure what that means. No doctors have discussed this with me yet. Seems if they take it out there shouldn't be any prostate cancer left? But then I read where people get it out and still have a PSA level, so like I said earlier, they must leave some in there, even when they call it total. Had to drive 150 miles to get MRI and biopsy They could have done that in Topeka, but KUMC is ranked as number 50 in top of prostate treatment so I went there Topeka doesn't have a Proton device, that would be back up to KUMC 150 miles RT. One of those radiations therapy is only a few days, not 30 some days. They do have SBRT radiation in Topeka, but I know of someone who had SBRT or maybe it was IMRT and it screwed up several other organs around the prostate, like bladder, kidneys and intestines.
Then some tell me I am lucky to have them all in grade group 2 or 3. But seems like I had a lot of them (12 of the 15) . So I would guess if they did 25 biopsy I could have had more grade group 2 or 3.
All confusing and stressful, other that this I am 78 years old healthy as a horse- no other issues and very active. Loss of what to do and all the different radiation types, that why just getting the pesky thing cut out of there, but seems they still leave some in.
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@wwsmith
While it would make sense that large cribriform would result in a high decipher, I have never heard specific information pointing to that fact.
The thing is large cribriform does mean that the chance of reoccurrence is very high, Which would correlate to a high decipher score?
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2 Reactions@jeffmarc That's what I was thinking too. Even with just what we know right now about the chances of reoccurrence being quite high with large cribriform pattern, I think it's safe to comment that one can think of the existence of large cribriform as being like having a high Decipher score.
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1 Reaction@diverjer I think your recent biopsy is the perfect example of why one should always have a biopsy targeted to known lesions that also includes samples taken across the untargeted areas of the prostate.
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1 ReactionThank you for all of your insights and definitions of the various terms and tests! I'm even a long time PT and this is new territory.
*I just had the fusion biopsy last week and my dr. called me yesterday to say that I had a 7 score, called it "...a more aggressive lesion". They took 15 cores and 3 had the bad boy cells.
*He is scheduling the special CT scan with isotope tracer to see if it has spread. He said that we would talk about options after the results of this test.
*My wife and I can't help thinking that causing all of those cores would stimulate a lot of inflammation and blood flow to heal the area, helping the cancer to blast right off of the launching pad?!
*I'll try to tune in the support group-what is the schedule of them? Each Wed. or Thurs. night?
Got a call today KUMC after that last post. That is Kansas University Medical Center (a 150 mile round trip), but it an easy drive.
They called me about the Biopsy and that I needed action, this was not a watch and see case.
They are going to get Decipher test (some kind of gene test???) using what they took from biopsy.
In one week I get a PET scan with an IV and suppose to scan me for 30 minutes, not sure why it takes 30 minutes?
Then in Early March have same day appt, 1 hour with a doctor in Radiology and another hour for a Surgical doctor in Urology.
Haven't a clue about this Decipher test, did see where it's graded 0 - 1 and you want it to be less than .45.
Then the Pet Scan is a 30 minute scan, does that scan just the prostate all that time or the whole body?
Hello All:
Thanks so much for your insights. I just returned from the fusion biopsy and now the dr. wants to do a special CT scan with a tracer to see if the cancer has spread. The score was a 7 now, up from 2 previous regular biopsies of 6 on my Gleason scores. He called that 3 cores of 15 taken were a more aggressive lesion type. He will give me options after the next scan.
@drcopp
If you had a biopsy, What was the Gleason score For those three cores. They are not a Gleason seven up from two since there is no Gleason two. Not quite sure what you even mean by that score.
After I had a second biopsy 16 years ago My doctor had me do a CT scan as well. The scan showed there might be something going on with the seminal vesicles. He then did another biopsy to check out my Seminal vesicles and did six cores as well. He thought that if my Seminal vesicles had something in them, I would need radiation instead of surgery. The six courses were all 3+3, The previous biopsy showed 3+4, but after surgery, they found 4+3. The biopsy sure doesn’t find everything.
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1 ReactionI keep thinking I should just get the prostate cut out and be done with it. No prostate, no worry about prostate cancer. But then I read these posts that people get it removed and they a few years later they have high PSA and prostate cancer- yet no prostate. Doesn't make sense.
Anyway I am still waiting on my PSMA Pet scan on 27th and results of Decipher test (whatever that is). Then on March 9, I talk to a RO, then a hour later with surgeon.
Maybe after surgery a few prostate cancer cells are left behind and attack something else? Then because they were prostate cancer cells, makes it raise PSA even though it might actually be liver or kidney that was infected with the left behind cells?
@diverjer
Liver and kidney getting prostate lesions is very unusual. Lesions to the lymph nodes, and the bone are the most common.
@jeffmarc Thanks Jeff, your name sounds Italian, I am also, half on my dad's side.
Right, I got the results and all of the cores showed a 6 Gleason score, so I don't know where he got the 7? I just wonder if the procedure of biopsy stimulates more cancer cell growth and spread?