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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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@charlesprestridge
Thanks, I been leaning toward Prostatectomy, but when talking with RO will ask about external beam radiation with HDR boost. I am in excellent shape, no one believes I am almost 79 and work out a lot and walk miles every day since moving to town. Use to be out in the country where I worked my butt off. Being a city dweller for the last 20 months has been a big change, so I found different ways to keep in good shape. Maybe moving to town is what gave me cancer- just kidding.
Well sometimes I wonder if I should take up drinking again? Seems nobody moves fast and just wait around for another test to come back. One test they should have sent in 2/10/26 and didn't send in until 3/2/26 that was the Decipher test, takes 3 weeks to get results. I just want to get something started, still leaning to get it cut out, but won't even schedule until results from Decipher test. This is a NCI-designated Comprehensive Cancer Center, but not impressed! Was impressed on how they handled wife's breast cancer. One month from diagnose to completed surgery with many test and scans- all in 30 days. Seems Prostate cancer is handled a lot different at KUMC.
Did see RO for an hour and she said as best as I can tell from my quick note taking:
Radiation Options and Pros/Cons
• Radiation makes BPH worse
• Brachial seed. She does not recommend for me. High risk because of urinary issues.
• Radiation can cause issue with the rectum and bladder. Rectum spacer gel minimizes rectum side effects.
• After radiation, increasing Flomax, add Cialis to lessen urinary symptoms
• There may be bleeding post radiation in a couple of years.
• There may be bowel urgency/blood in stool down the line. In 1 to 2 years.
• Erection functions have better outcome with radiation. Nerves may be cut during surgery. However, radiation may cause blood flow issues from scar tissue after radiation.
Quick summary from RO of what to do:
• Hormone therapy – ADT for 6 months. Shrinks prostate by 1/3. May produce hot flashes, fatigue, and muscle/bone loss
• use some rectum gel
• add some markers
• Recommended radiation: 28 treatments IRMT or 5 treatments SBRT
Notes from Surgery visit as best as I can tell from notes:
The Surgery doctor, said done over 2,000 RP recommended:
• Stage? Clinical State is T1C, but what I said was also accurate, I said T2 N0 M0 (confuses me clinical stage vs what I thought) Seems there are other stages than clinical and one of them is the one I said. Confusing!!!
• 5th Rib Issue, cannot biopsy to small of spot that showed on PSMA test
• SUV on Rib??? Chest CT in 3 mos. after PSMA. Can reach out to radiology for SUV result and why they didn't give us SUV on 5th rib. They gave my prostate a SUV of 11.1
• Cribriform - Gleason Grade Group 4. At higher end of intermediate.
• Staging is tricky in prostate cancer, can only tell after prostate is removed
• Goal is for cure and no biochemical reoccurrence.
• Benign surgeries cause issues. Stress incontinence for a year or more.
• The surgery is robotic and surgery is perfomed by Doctor. Residents may assist or observe only. Incision is through the belly. The lymph nodes are taken out. No lymphedema will happen. I said MRI said nodes were fine, he said they need to come out anyway
• Cons of surgery. Age influences outcomes. Prior aquablation and Urolift will make recovery longer and harder to connect urethra back up to bladder.
• Pelvic floor physical therapy can improve outcome.
, Will not schedule until he has the Deceipher test to see those results. And then at least a month out.
This is a mess of a post, but best I could do, felt most comfortable with surgeon, still confused on iwhat he thought of nerve sparing or not for long term?
No matter what I wait 3 weeks for that test they waited forever to send in.
If you have surgery, the amount of incontinence you can have is quite variable. I had none which about 10% of people have. Having it for a few months is not unusual. Having it for a year is unusual, If you work on it, you can usually learn how to do Keagle’s properly to avoid it Continuing to be a problem.
Getting a cure in prostate is cancer unusual. Long-term Remission is more common. If you have a 3+4 and it has not spread anywhere else then that may be possible. If it is spread anywhere else, then you can expect for it to come back at some point, It could be decades it could be less time. In your case, a cracked rib can show up like something, but no SUV and it’s probably not cancer.
If it’s isolated to the prostate, then SBRT radiation works quite well and most people have minimal issues just with urinary problems.
The N0 says that nothing was found on the lymph nodes. Hopefully, they only take out a few, five or less. Taking out too many can be problematic in the future.
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4 ReactionsYes, it did sound like only a few nodes, the MRI said they were free of cancer, perhaps he wants to test a few? I will talk with him more before actual surgery date. Did get a few more details from him in notes, he will do more, but not done yet. New notes from nurse below:
-Nerve sparing vs non nerve sparing: Dr. would not recommend a nerve sparing approach due to the MRI findings and extent of the cancer. Dr. would favor a wide dissection which would lead to no natural erectile function after surgery. (did wonder why they added natural in front of ED, seems they would just say no more sex, sorry)
-Decipher testing: While not imperative, it would be recommended to wait until the Decipher test results are received before scheduling any potential surgery. These results are still pending and should be finalized in the near future.
-SUV on PET scan: I will contact the radiology department to ask that a radiologist re-reads your PET scan to report the SUVs. I will follow up with you once they have a chance to review and respond to this request.
-Clinical notes: You will be able to view more, Dr. clinical notes once they are finalized/sign by the provider. You will be notified on MyChart when the note is completed.
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1 ReactionMayo Clinic had their monthly meeting this week. They Talked about erectile dysfunction.
One thing that he really talked a lot about was the implant. It’s implanted inside your penis and it gives you an erection whenever you want one. It is extremely popular 80 to 90% of the people really like it. Gives you an erection on demand. There are a few people in this forum that have had that done and they really have liked it.
Don’t let the loss of the ability to get an erection make your decision. The implant is covered by insurance. The penis looks almost identical to what it looks like normally with an erection.
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4 Reactions@diverjer No, it’s a great post because you stated all the pros and cons for both treatments and it reads like a damned if you do damned if you don’t list…🤯🤯🤯
This is EXACTLY what prostate cancer is all about!
I am impressed with both practitioners NOT sugar coating their respective treatments - especially a surgeon who tells you bluntly that you’ll never get it up again…unheard of these days.
It doesn’t seem that the Decipher test is going to be the dealmaker/breaker for your treatment.
Both Drs are indicating that they will treat you as a more aggressive case (ADT from the RO and non nerve sparing from the surgeon) so I think you have to really start thinking about things like your age - life expectancy vs possibility of recurrence - and overall general health; which procedure will do the job AND make you the least miserable going forward.
Phil
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3 ReactionsAccording to your stats you have cancer (tumor) obviously, so you have choices. Depending on location (next to colon wall, centralized. If next to colon wall, I highly suggest RP. If that tumor metastasizes, then you'll have to deal with colon cancer. If the tumor is centralized you have more time, but I wouldn't waste any time. Up to you, do nothing and watch, radiation, or RP. Watch to see how long your PSA's take to climb, various radiation treatments (seek an oncologist as well), or remove the prostate and deal with the effects. Nothing good about cancer, but the good is either rid it or control it. My case, I just had the prostate removed since the tumor (small was against the colon wall.
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1 ReactionPSMA showed cancer in Peripheral Zone and Transition Zone. I believe the Peripheral Zone is close to colon. Anyway, since the beginning of all this I pretty much been saying just cut the thing out and be done with it. In fact when I seen the surgeon, I said why don't we just do this tomorrow. I have talked it over with wife and we agree the RP is the way to go.
So now we are just in that waiting stage for decipher test to get back to doctor and get on schedule. Seems like a lot of waiting for everything.
@diverjer Yes, confusing. My husband is, I believe, 4+5 (or 5+4). At any rate, high Gleason score. Advanced Prostate Cancer - no metastases. Wondering what to expect from 44 radiation treatments plus oral ADT. Thanks to all who share their experiences.
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1 Reaction@franciekid
You’ve been here for three years, so I’m not sure exactly what you’re asking for.
The results for a 4+5 after 44 radiation treatment treatments and oral ADT for 18 months to two years can be long-term remission or short-term reoccurrence. Getting a decipher test can tell you what the likelihood is of having the reoccurrence soon. There’s no model you can go by to tell you that this is going to work, one way or the other.
I know many people that have had radiation and ADT and are around many years later asking about what to do when their cancer reoccurs. I know one guy that’s been on five vacations from ADT, Many years out from initial treatment. His vacations from ADT become shorter, but he’s still able to live without it for a good amount of time.
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