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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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This sounds like relatively good news as if I read it correctly the cancer is contained in the capsule. My husband has 3 Grade 5 lesions and altho no metastases, cancer is outside prostate which, I think, puts him at Grade 3C. His cancer is also aggressive.
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Yes I posted the PSMA results above and the only place that got a score was below and on phone call he called it Grade Group 3, unfavorable and intermediate:
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).
The rib didn't give a score as the PA said in note today that "It was a solitary & suggestive of benign lesion" However that is not what was said in the PSMA radiologist report I posted, it hinted that it could be nothing or it could be as stated below::
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 and then said:
That doesn’t make me feel all that great as radiologist also just said “Osseous metastasis is not entirely excluded. Recommend continued attention on routine oncologic follow up imaging of the rib”
Especially since I have read that the cancer can skip the nodes and likes to go to ribs and spine. PA also didn’t mention all those other baselines SUV.
As you all can tell, I am confused.
@franciekid I meant Stage 3C, not Grade. 3 of his biopsy spots were Grade 5 - aggressive.
@franciekid
I haven't figured out all these scoring systems, between scoring and terminology my head just spins. You have those 4+3=7, the grade groups, then I believe there is a stage? Why can't they use one method of staging? Then some say my cribriform, moves you up one, but not sure of which scoring it moves you up. Then a 7 can be a grade group 2 or 3, depends on if it was 4+3 or 3+4.
@diverjer There are a number of fluids, tissues, and organs that express PSMA without being prostate cancer, and will show “increased radiotracer uptake” in a PSMA PET scan. A person who is well-trained in reading PSMA PET scans will see these and know there’s a low likelihood of it being prostate cancer.
As Dr. Johnson (of Mayo Clinic) mentions in that presentation I sent you previously, an MRI might see all sorts of lesions (like bone and rib lesions), and not be able to tell whether it’s an old healed break, a sclerotic remnant, a fibrous dysplasia, or prostate cancer.
However, if that suspicious rib area is expressing PSMA and shows “increased radiotracer uptake” (of what SUVmax?????), then the likelihood of it being prostate cancer is higher (which is why they concluded that “Osseous metastasis is not entirely excluded. Recommend continued attention on routine oncologic follow up imaging of the rib.”)
If it were me, I would be confused as well and would ask them to further investigate this. After all, if this is a metastasis (and hopefully it’s not), it would totally change treatment management.
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2 ReactionsThe groups recognize that 4+3 (group 3) is much worse than 3+4 (group 2). A 4+4 is group 4. Your stage should be IIC (4+3 or 4+4 with PSA< 20 within prostate so no lymph node or metastasis). Note that 4+3 is grouped with 4+4 (Gleason 8). You might be treated like a 4+4 due to cribriform.
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2 ReactionsFrom what I can figure I am a 2C, if the rib thing is not Osseous metastasis. If it is, well things are a lost cause. More I read it seems a lot of things express PSMA uptake, but for whatever reason they didn't assign a SUV to rib? PA-C said because It was a solitary & suggestive of benign lesion and that is why, but he is not a radiologist. I am going to try to get them to biopsy it or something when I see them on 9th. Here is a place I found interesting for staging, don't know if accurate, but seemed to be? https://ro.co/health-guide/prostate-cancer-stages-and-grades/
@diverjer I had similar results from my PSMA - a lesion on the lateral crest of the hip; I was scared **itless!
My RO said it was not metastasis since not much showed anywhere else and it would be unusual (but still remotely possible) to see a definitive lesion so far away from the prostate bed with nothing in between.
In other words, you’d see a ‘trail’ of spots leading from point A to point B. You should be OK.
The radiologist has to cover his butt by saying metastasis is not entirely excluded.
Phil
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2 Reactions@heavyphil
Thanks for the information, gives me a little better feeling. Did they also not assign your hip a SUV? Did the assign your prostate with a SUV? However, I would like them just to cut the area open, grab a chunk and look at it under microscope. Well will see, but doubt they think like I do?
Then do still wonder why no SUV number assigned to rib area? They assigned an SUV to prostate 11.1. They said rib area had uptake! If something has an uptake, why not assign SUV. I know what the PA said because "It was a solitary & suggestive of benign lesion and that is why". But the report doesn't call it that, report just says UPTAKE.
@diverjer
A rib that I had broken in the 20s is listed as having focal uptake. No SUV since it is not showing any metabolic activity.
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