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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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Yes the rib thing was something I never notice or had an injury that I remember. Use to ride dirt bike motorcycle racing and lots of wrecks, and thrown from horses a few times.a
The PA-C did call tonight and was sorry, still hasn't sent in Decipher test.
Said my PSMA Pet Scan showed Prostate Cancer, he would say Grade Group 3, unfavorable and intermediate.
Said really good that it didn't find any bad nodes.
Didn't believe it was fast growing, but don't wait a long time to get treatment, month or two should be okay.
That he would get the Decipher test sent off to Verisite as soon as possible.
Should follow up on rib thing, but it is not from prostate.
And that is all he said, said the Decipher test wasn't that critical for my upcoming appointments with RO and surgical doctor. I question that some
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1 ReactionWas surprise the injection F-18 Flotufolastat (Posluma) IV stuck to the rib, thought it only attached to PSMA proteins, but report seem to not be so sure. Guess they want a follow up image, so will check out when.
Still want to get it cut out and hopefully don't have issues like incontinence. Then need to talk and learn about nerve sparing vs no nerve sparing.
Think I should hold off on sex and let this injection radiation get out of system., will at least 24 hours.
@diverjer Posluma® is the newest of the 3 available PSMA PET scans. (The other two are Illuccix® (Gallium68) and PYLARIFY® (Piflufolastat).
They found an area of interest on your left posterior 5th rib, more likely scar tissue but worth following up on.
> Did they assign an SUVmax score to this area of interest?
The SUVmax score of the lesion in your prostate was 11.1.
> In the PSMA PET scan report, what were the SUVmax scores they assigned to your blood, liver, and parotid glands? They’ll compare your “SUVmax 11.1” score to those 3 SUVmax scores in order to grade it.
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1 Reaction@diverjer That would really twist my horns; doesn’t sound like this center of excellence really IS.
My friend’s wife just had radiation tx at Moffitt in Florida for breast cancer…what a disaster!! Doctors in Singapore (where she comes from) found cancer in 3 ribs and had to do radical mastectomy and replace the ribs with titanium.
The docs there were stunned at the ineptitude of the US hospital - evidently they never did a PET scan.
I guess some CoE’s are more ‘excellent’ than others. Maybe you should get outta there once they tell you what their treatment is going to entail, and get a second opinion somewhere else.
So far your PET looks good so if your Decipher comes back low, treatment should be fairly straightforward…that is, if an experienced surgeon or RO is doing it and not a resident.
Mistakes and incompetence are hard to rectify after the fact!
Phil
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1 Reaction@brianjarvis
I posted the report they put on MyChart, no mention of blood, liver, and parotid glands. I would assume they only assign SUV score to something that had some uptake and these had no uptake.
Now sound like some uptake on rib, but no score. Maybe not enough to score, I don't know.
@diverjer If the PSMA PET scan report doesn’t reference the SUVmax scores of your…..:
> lacrimal (tear) or parotid (salivary) glands
> liver (hepatic)
> blood
….then, they left it out for some reason.
As it turns out, PSMA (prostate specific membrane antigen) is not really “prostate specific.” There are other organs, tissues, and fluids that naturally express PSMA (without being cancerous) and will show up as physiologic tracer uptake on a PSMA PET scan - particularly in the lacrimal (tear) and parotid (salivary) glands, blood, liver, spleen, pancreas, ganglia, and more, as well as the kidneys, ureters and the bladder (as the body tries to quickly excrete the radioligand that was injected).
So, they use for comparison the PSMA SUVmax values of your blood (as the lowest level), liver (as the medium level), and parotid or lacrimal glands (as the highest level) of SUVmax expression.
If a suspicious area (lesion) is expressing PSMA, and it has:
> a PSMA SUV score less than blood, then it’s not likely cancer, but instead just normal, background PSMA cellular expression;
> a PSMA SUV score greater than blood, but lower than liver, then it’s likely low-grade prostate cancer;
> a PSMA SUV score greater than liver, but lower than the lacrimal/parotid glands, then it’s likely moderate-grade prostate cancer;
> a PSMA SUV score greater than the parotid/lacrimal glands, then it’s likely high-grade prostate cancer;
It’s important to know where your 11.1 SUVmax falls on that blood-liver-parotid(or lacrimal) SUVmax range, because that might drive what treatments you get.
As always, discuss all this with your doctor.
Dr. Johnson (of Mayo Clinic) talks about this in his presentation, starting with the scans we’ve all heard about (MRI, bone, & CT scans), and then going into detail about PSMA PET scans: https://youtu.be/JoJomACA5UM
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2 ReactionsWow, how you learn all this stuff. I am going to try and ask them about this and hope they don't get too mad. They shouldn't get upset, but they might?
Update I asked, wonder what kind of response, if any, I get back.
@heavyphil
Like I posted, they did really good with wife's breast cancer and super fast. From finding cancer to removal of lump in a month. Made the trip to clinic about 2 times a week for various test, didn't mind even though it was 150 miles RT. Now on me with a different department in the clinic, I wait more than a month for a single test. Then another month for a followup test that sounds like isn't complete.
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1 Reaction@brianjarvis
Well, I pretty much copied what you posted and this is what I got back, didn't really answer a lot of what you talked about. The Dr. Duchene & Dr. Kane he mention are the RO and surgical doctors I see on 9th. Never have seen them before, that will be first time. Response below.
Thank you for your MyChart message.
No, the radiologist did not assign it a SUV score. It was a solitary & suggestive of benign lesion. Dr. Duchene & Dr. Kane will certainly use all the information available to provide you with treatment recommendations specific to your situation.
If you have any additional questions or concerns, please do not hesitate to contact my office.
Respectfully,
@diverjer That’s an interesting response.
> “No, the radiologist did not assign it a SUV score. It was a solitary & suggestive of benign lesion.”
In an earlier post, you mentioned “…The PA-C did call tonight and was sorry, still hasn't sent in Decipher test. Said my PSMA Pet Scan showed Prostate Cancer, he would say Grade Group 3, unfavorable and intermediate.”
If it was a benign lesion, then they would not have assigned an SUVmax score to it (& therefore, no reason to mention SUVmax scores of blood/liver/parotid; though, it still would’ve been good to know how thorough they were being.)
However, if it was a “Grade Group 3, unfavorable and intermediate” as your PA-C indicated, then it would’ve had a SUVmax score assigned to it (probably between the SUVmax scores of blood & liver or liver & parotid).
Still, worth following up on to insure you’re getting consistent information from your medical team members.
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