Anyone with PIRAD 4 score and not diagnosed with cancer?

I know people with a PIRADS 4 That have had a negative biopsy, but you have to realize that only one percent of the prostate is access during a biopsy so there is a lot of area that is Missed. I know a number of people who had various PIRADS scores and the cancer was found in a different spot that did not have a score.

You could get a PSE test to see if there is cancer found in your blood, If it is, then you do need a biopsy.

A PI-RADS 4 lesion on mpMRI is typically associated with about a 35–45% chance of clinically significant prostate cancer on biopsy.

In my original mpMRI, PIRADS 3, 4 and 5 lesions were found. My targeted biopsy indicated the 4 and 5 lesions were 5-10% Gleason 3+3 and the PIRADS 3 was benign.

By the 12 month follow up
mpMRI the 3 and 4 lesions were no longer visible and the PIRADS 5 was downgraded.

At my most recent 28 month follow up mpMRI, all three original lesions were no longer visible.

I did have a Decipher score of 0.22 and my PSAV is negative after 2.5 years, so my experience may not be typical.

IMHO you want to be looking at as many markers as possible, not just your mpMRI; including PSADT, PSAV, your Decipher Score (assuming a biopsy) and any other biomarkers your urologist is willing to order.

did you have any treatment or did the lesions resolve on their own?

@keithl56

No medical treatments, I’ve been on AS for 2.5 years.

I will continue to monitor closely, as a new single PIRADS 4 lesion (much smaller than the original lesions) was found in an area of the prostate that my urologist indicates has an even lower probability (single digit) of being clinically significant…probably also inflammation.

My latest mpMRI indicated there is evidence of prostatitis.

My originally diagnosed low risk PCa is something to continue to monitor, as multiple markers indicate stability.

I’ll get another mpMRI in 12 months, while continuing to monitor my PSA on a 6 month schedule.

@handera
Sounds like you were very fortunate. I intend to be proactive and get a second opinion from Johns Hopkins before I make any decisions.

@keithl56

Well…I’m all in regarding my implementation of the ERASE randomized clinic trial protocol.
https://jamanetwork.com/journals/jamaoncology/fullarticle/2783273
Whether this protocol has anything to do with my current results, I remain optimistic; but I give thanks and credit to the Great Physician for any positive results I may be experiencing.

The protocol looks interesting. Unfortunately, I have other medical limitations that would prevent me from participating in anything like that.

To add my answer to the original post - yes, I had an MRI that showed a PIRADS 4 lesion and a subsequent MRI-guided perineal biopsy which included 4 samples of the PIRADS 4 lesion showed no cancer. I had a subsequent MRI 18 months later due to an elevated Exo-DX score and that MRI showed nothing in the location of the earlier PIRADS 4 lesion. I do a lot of relatively long distance bike riding and the MRI that showed the lesion was at the end of a cycling season, and I suspect that the lesion may have been due to the bike riding.

I had a saturation biopsy, after the second MRI which came back completely clear, due to the elevated Exo-DX score, and that did show a small percentage of prostate cancer. I think the earlier PIRADS 4 finding on the first MRI was unrelated however to the later finding of prostate cancer.