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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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@diverjer
It’s not really a BRCA2 test. It’s an hereditary, genetic test. There are many different genes that can be found in some of them and they can cause aggressive prostate cancer problems. ATM and Lynch Syndrome are two among a number of issues that can cause real prostate cancer problems.
You should get one. It will not delay any of your recommendations. It will give more information as to what possibilities there are in the future. Some medical offices do them as a matter of standard procedure.
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1 Reaction@diverjer Hi there welcome to the Steep Curve Learning Club. I noticed some questions you have about men having their prostate removed and still having prostate cancer. My husband went into his prostatectomy knowing he had aggressive PCa in his prostate and two nearby lymph nodes. The plan was to have the surgery and then radiate the nearby nodes. They removed the prostate and the nearby nodes. Unfortunately the PSA kept rising and a new activity was found in more lymph nodes. The thing is…the scans don’t show the micro metastatic cells. They can be anywhere at any point in the treatment process. Who knows when and what journey they have taken from the prostate to other parts of the body. Fortunately there are now treatments available for all kinds of situations. Sorry to say the waiting is unavoidable. Please know the people in this group totally understand what you’re experiencing.
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5 ReactionsWill still no results from the Decipher Test, I asked and they say it might be weeks. Suppose to have sent it off on the 10 of February.
KUMC is a NCI-Designated Cancer Centers so I keep trying to put up with getting no where for the last month, this all really started with an MRI January 15. Well actually in mid Dec, it took a long time to get the MRI. This Friday get a PSMA Pet Scan and suppose to finely see RO and Surgeon on 3/9. I am thinking, just get darn thing cut out and that will take care of the issue, but they want to do all this testing and then if they do say removal is option, who knows how long I would have to wait for surgery.
Then not sure I want them to do surgery, yes they are a NCI-Designated Cancer Center, but also a training hospital. When I had them do an Aquablation in 2024, I found out after the fact it was done by a Resident- not my surgeon. Aquablation didn't help much and after my real surgeon did another scoping he said there was some stuff left behind and I needed a revision surgery. I said no and just went back to Flomax.
I don't want a resident doing the prostate removal, I want the guy with lots of experience and success who I will see on 3/9/26. But since this is a training hospital, I don't know if that is something I can demand? I could get it done here in Topeka with a person with lots of experience and seems to have a good record, but like the idea of being treated at a NCI-Designated Cancer Center. Locally here in Topeka they wouldn't have done a PSMA Pet or Decipher Test.
@diverjer I think you should have a very frank discussion with your surgeon; residents do scrub in at teaching hospitals and perform much of the ‘opening’ and ‘closing’ along with OR nurses.
But the most delicate parts of the procedure - the dissection and removal - should be done by the person signing his/her name on the surgical report.
If the surgeon nods his head and tells you “this is a teaching hospital” or mentions ‘the doctors of tomorrow’ then rest assured an inexperienced (sorry, that’s the word to use) resident is doing your surgery.
I understand it, and I know that hands-on experience is priceless, but so is MY body and I deserve the best if I can get it.
Phil
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3 ReactionsThanks, I plan on having that discussion, hope it doesn't get doctor upset. This will be our first encounter.
Your Gleanson is firmly 4+3 unfavorable. Intervention is needed.
Do a Decipher test and PSMA test. These two will tell a lot more.
Good luck.
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1 Reaction@diverjer I’ll be the first to admit that it is an uncomfortable discussion. However, it does not have to be confrontational. You can open the discussion by saying, “I understand this is a teaching hospital, but will YOU be doing my surgery, or someone else.”
His answer will determine your next question - ie, “what part will YOU be doing?” And take it from there. You do have options.
Well last night I got a MyChart message that the PA who did the biopsy didn't send the biopsy off to get the Decipher Test as he said he would on Feb 10. Instead he took time off and didn't return until the 25th. Therefore, nothing was done! So since they take about 2 - 3 weeks for Decipher Test results they won't be ready for doctor appt on 9th. Makes me wonder, Jim the PA wouldn't actually package up and send samples off himself. All he needed was to send instructions to have it done by pathology or some other department. Hopefully biopsy are stored correctly or they are worthless for RNA Decipher Test!! Also, if like local procedures (where I have family working), Dr Neff would have had to sign off on PA Jim before they would be sent off. This KUMC office does not have their act together.
Today is the big PSMA Pet Scan, hope they do it right. KUMC is the only National Cancer Institute Designated Comprehensive Cancer Center in 500 miles, but not impressed. They were good with wife's breast cancer back in 2019, but this department seems to be falling short. The surgeon they assigned and RO are different doctors that I have never seen before, but I think from same department? Anyway the surgeon may be from same depart as Dr Neff and PA Jim? Dr Neff is the one that was suppose to do my Aquablation and it ended up a resident did it. Found that out after surgery. Procedure didn't do much good and after scoping Dr Neff said I need a revision as there was still blockage. Which to me meant resident didn't do it right. But this dime they assigned a different doctor for cancer.
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2 ReactionsWell got the PSMA Pet scan today they used some tracer injection F-18 Flotufolastat (Posluma) IV. Then about 10 minutes I got these results on MyChart. Don't know if more will come or when a doctor will review? I thought it would mention nodes or something, but so far this is all. Hopefully I get it explained, I thought you got more information.
1. Multifocal primary prostate neoplasm.
2. Focal increased radiotracer uptake in the left posterior fifth rib, which statistically reflects a benign entity such as fibrous dysplasia. Osseous metastasis is not entirely excluded. Recommend continued attention on routine oncologic follow up imaging.
By my electronic signature, I attest that I have personally reviewed the images for this examination and formulated the interpretations and opinions expressed in this report
Finalized by Coulter P Cranston, MD on 2/27/2026 3:51 PM. Dictated by Mitch Misfeldt, M.D. on 2/27/2026 3:33 PM.
Narrative
NM PET PROSTATE
Radiopharmaceutical: F-18 Flotufolastat (Posluma) IV.
Clinical Indication: Prostate cancer
Technique: PET imaging was performed from skull to thighs after tracer administration. Low dose non-contrast CT imaging was performed for attenuation correction and localization purposes.
Comparison: External MRI pelvis 1/15/2026
FINDINGS:
Head/Neck: No suspicious tracer avid lesion.
Chest: No suspicious tracer avid lesion.
Abdomen/Pelvis: Multifocal increased radiotracer uptake throughout the prostate gland (including the peripheral and transitional zones). Representative lesion in the left transitional zone at base to midgland has a maximum SUV of 11.1 (PET image 306).
Osseous Structures: Focal increased radiotracer uptake in the left posterior fifth rib.
I KNEW ABOUT THE BELOW, HAD SINCW THE 1980s:
CT Findings: Coronary artery atherosclerotic calcification. Calcified granulomas. Right renal cysts. Aortoiliac calcified atherosclerotic plaque. Occasional colonic diverticula.
@diverjer
Sounds like they didn’t find much unexpected. Just the prostate.
I also get that kind of warning about a rib that broke when I was in my 20s.
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