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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
As @heavyphil mentioned, sometimes benign things "glow".
I mean, every single scan that we have is open to interpretation and SUVs are there as something that is "suggestive" but often not definitive.
The same applies to MRIs and even just simple X-rays etc. Radiologists see hundreds and hundreds of scans and have to rely on experience a LOT, beside regular parameters. As Phil also mentioned, sometimes the mere placement of a glowing spot can be suggestive that a spot is probably benign.
My husband had one lymph-node with faint uptake and 2 separate radiologists as well as surgeon told us that it is benign (???), now don't ask me how they concluded that - yes uptake was faint BUT - it is still making me nervous as hell. My husband thinks that since his post-op. PSA was so low that it could mean that indeed that particular node is glowing just "for fun" XP, but it is in the back of my mind all the time : (((.
Perhaps you can ask for a second opinion about your scan ? Why not ? Let a radiologist in some other hospital read your scan and tell you his opinion. And, I also agree with you - if it is possible to have a biopsy of that spot, it would be ideal scenario. I wish our surgeon removed some nodes for biopsy during surgery but he did not even though we asked him to do that : (((. *sigh
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5 Reactions@diverjer Please don’t get too far in the weeds with SUV #s! It is just a number used to reference the uptake of tracer; and since many body parts and older injuries and inflammatory conditions exhibit uptake, you can stare at that PET scan until you go blind and interpret it any way you like.
It is WAY TOO EARLY in your new reality to start getting hung up on the mechanics of nuclear radiology!!
It’s good to know terms, it’s good to question, but leave the minutiae to the ROs; they know more than our Google search will ever tell us and have years of experience interpreting scans and weeding out the relevant data.
In the beginning, I too dissected every word, tried to interpret every nuance, read everything I could get my hands on. I have something of a scientific background so it was only natural to be inquisitive…But
After many months of that I was physically sick of it and I decided to let go and let the doctors do the heavy lifting - not me.
This is a nut twister of a disease and it is anything but straightforward so please try to relax and not think that everything is etched in stone. You’re going to find that it is only written in pencil, erased numerous times and what you are seeing today could change tomorrow. Best,
Phil
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5 Reactions@heavyphil
"This is a nut twister of a disease and it is anything but straightforward so please try to relax and not think that everything is etched in stone. You’re going to find that it is only written in pencil, erased numerous times and what you are seeing today could change tomorrow. "
Oh boy - no truer words have been told ... *sigh
I do not even know how any of us here stay sane XP. It has been a year since I came here and half of my brain is scrambled and who knows what is ahead and that "ahead" can be like "tomorrow" or maybe in 5 years or later with help of divine providence...
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4 ReactionsThanks I appreciate all the information. I know a lot of my problem, and I been told this many times, is that I over analyze everything. But there is good reason for that over analyzing, I spent over 40 years as a computer system software technician for the state of Kansas working on large mainframe systems. In that line of work, there is no gray area, there is right or wrong- fix it now. Couldn't say I think this or that, or we will wait and see etc. I would get called in in middle of night and weekends to go in fix issues- they couldn't wait. And that was a 35 mile drive one way. I couldn't say, well I think this is what is wrong, lets wait and see.
I know medical field is not that way, but hard for me to change my thinking. I sure this is a dumb question, but not sure what XP means, in the computer world it was a release of Windows that means eXperience. I have seen XP in several post.
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1 Reaction@diverjer
I spent 50 years in Computers. The first 25 I worked on IBM main frames. I was an operating system programmer and spent many years writing assembler language doing updates to new versions of the IBM OS. I even hired IBM SE’s to work for me. In 1983 my company installed a 4800 baud modem in my house Along with a 32 line 3270 terminal. I was able to test operating system changes on the spare $6 million manframe they had, from home. I was able to reboot partitions using VMware. Over those years I had to write code in probably 15 different languages. I also designed networking solutions on Vax VMS, Tandem Tal, IBM mainframes and PC’s, some in their assembler languages,,allowing them to move data back-and-forth between them.
The last 25 years I ran a consulting business. Had almost 100 companies I did all of their support for. Of course this was with Microsoft servers and PCs, Though I did do a some Mac work as well. Learned how to do it all on the fly. Things are so similar.
Getting things exactly right is critical With Computers.
Getting it right with prostate cancer is important too, but there are so many choices. There is no one right answer. You may not find out for years if what you picked is the correct solution. People in this forum can find out a lot of Solutions and take their pick of the one they want to use.
Don’t get too far in the weeds here. At some point, you have to make a choice. One guy I know has been to at least six different doctors to get a second opinions. He is an engineer and has an engineering mindset, and can’t let go and make a decision. He’s got large cribriform And still won’t make a decision on how to be treated. Something like that can be a deadly decision, not to decide.
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3 Reactions@jeffmarc
Wow, I did assembly programmer also. Went to school wanting to learn COBOL, but they had a requirement that I first had to take Assembly and learn to read Hexadecimal and Binary. Didn't want to learn that, but really paid off later as most staff didn't know things down to that level which was really needed looking at core dumps. Mostly IBM ESA, but also did work on Univac, IBM System 3 15D, IBM Series 1 and even some Control Data Systems (CDC). Then had to also get into Micro Computers. Before I had to support them, I made fun of the PC staff, called them Micro Brains.
@diverjer
The only way to really debug cobol is to read the dump, go through the hex and figure out why the code went wrong. I had people come to me for help with that.
I worked with first generation second generation and third generation IBM Computers. First generation had vacuum Tubes, A drum that was like a small disc drive and punch cards. Sounds like you had a wide range of experience with different operating systems. When writing code is just how do you do that thing in this language?.
Learning all about prostate cancer was Like learning how to use computers. So many things. Just learning to understand reading a biopsy Going through clinical trials and analyzing the results. Gets really complex, just takes time.
@diverjer
So sorry for using "kid's" texting "lingo", I never grew up, I guess, and I text a lot with friends - "XP" stands for a "smiley face" that has a tongue out.
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3 Reactions@surftohealth88 😛 this one?? That’s what you’ve been saying all this time?!🤣
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1 Reaction@diverjer The craziness in my numbers came up after surgery. (I'm 68, diagnosed at 66) Biopsy (July 2024) had me at 4+3. Surgery (November 2024) had me at 4+5 with several adverse factors, including cribriform (probably why they changed the 3 to 5), multifocal and bladder neck invasion. My PSA remained low but was trending up, so we started hormones in October (Lupron) and 39 radiation sessions that ended a month ago. I'm still waiting for a report on how effective the radiation was. Next appointment is in 2 weeks (6 weeks after radiation), It seems it's not uncommon for them to get more clarity with each additional step. Hang in there.
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