@brianjarvis

Agree with your statement (and my urologist’s comment) regarding the inaccuracies of mpMRI's. In fact, I would broaden that statement to include ALL PCa related tests and procedures….including all the new urine and blood biomarker tests AND even biopsies themselves!

For someone diagnosed with low risk PCa, the ONLY thing that really matters are TRENDS...where one compares “apples with apples” the results of repeated tests, calculated parameters and biopsies.

I’ve had 3 mpMRI’s, 9 PSA tests and one biopsy over the last 2.5 years.

As of today, my trends include:

1) Post biopsy PSA doubling time (over 2 years and 9 PSA measurements) of 12.3 years.

2) PSA Velocity of 0.255 ng/ml/yr between Feb '24 and Feb '26

3) PSA density = 0.179 (10/23) at diagnosis, 0.157 (10/24) and dropping to 0.145 (02/26) most recently.

4) mpMRI results:

(10/23) - Volume: 43.5cc, 3 posterior peripheral zone lesions (2.1x1.1cm, 0.7cm, 0.9cm), moderate abnormal DWI/ADC signaling, largest lesion suspicious for mild local EPE. CONCLUSION: PIRADS 5, PIRADS 4 and PIRADS 3 lesions in the posterior peripheral zone, with indistinctness of capsule raising suspicion of extraprostatic extension only for the PIRADS 5 lesion, no evidence of seminal vesicle invasion or pelvic metastatic disease.

(10/24) - Volume: 43.3cc, 1 posterior peripheral zone lesion (1.9x1.1cm), the other two posterior peripheral zone lesions not visualized, mild abnormal DWI/ADC signal for the one posterior peripheral lesion (not given a PIRADS score), mild local extraprostatic extension not excluded.
CONCLUSION: stable posterior peripheral zone lesion, previously seen peripheral zone lesion not visualized, no new suspicious lesions,

(02/26) - Volume: 44.6cc, all original peripheral lesions not visualized, but diffuse strained appearance of peripheral zone may reflect prostatitis, 1.1x0.4cm left apex, anterior central gland near urethra, extraprostatic extension is highly unlikely (rated 1 out of 5). CONCLUSION: PIRADS 4 lesion measuring 11mm x 4mm centered at the left apex anterior central gland with no evidence of extra prostatic extension, seminal vesicle invasion or pelvic metastatic disease.

My urologist's recommendation, based on my trends, including my 0.22 Decipher Score and his knowledge of the location of this latest mpMRI lesion, was that another biopsy was not necessary, at this time, and to continue monitoring.

We did discussed the use of the newest MPS2 test; which I will request in the future, before undergoing another biopsy. MPS2 has an incredible NPV of 99% for GG3 or higher cancers and detected 94% of GG2 or higher cancers.
https://www.urologytimes.com/view/mps2-test-validated-for-detection-of-high-grade-prostate-cancer-in-non-dre-urine