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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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HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
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Hi Jefff,
I found a video of Dr. Mach Roach talking about side-effects of radiation.
Somewhere in the beginning he said “I don’t do Brachytherapy anymore” and
that is very disappointing because Brachytherapy HDR and LDR are the most
effective way to kill cancer.
You mentioned Rick Davis had radiation therapy from Dr. Roach and perhaps
there was another person you mentioned whom Dr. Roach treated. Did they did
Brachytherapy?
Thanks
Gouri
On Sat, Mar 14, 2026 at 4:24 PM Mayo Clinic Connect < nf+27a8128e+106063496@n1.hubapplication.com> wrote:
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> *Message*
> @ambika
> You get a PSMA pet scan. Frequently the reoccurrence is due to a new
> metastasis. They can be zapped with SBRT radiation as long as they are not
> in the area that has already been given lifetime radiation
>
> Other than that ADT plus an ARPI is the current solution if chemo or
> Pluvicto do not resolve the problem. You normally will not get chemo or
> Pluvicto unless there are multiple metastasis.
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@ambika
My brother also was treated by Mack Roach.
I know quite a few other people that have been treated by him in both the ancan.org Online advanced prostate cancer meetings, and the UCSF online meeting.
While brachytherapy Is effective so is SBRT. SBRT causes fewer urinary issues than brachytherapy.
There are several discussions related to brachytherapy for prostate cancer, including these: - Brachytherapy? Anyone have thoughts? https://connect.mayoclinic.org/discussion/brachytherapy-anyone-have-thots/ - Immediate Side effects of Brachytherapy https://connect.mayoclinic.org/discussion/immediate-side-effects-of-brachytherapy/ - Brachytherapy: Regrets & Why ? https://connect.mayoclinic.org/discussion/brachytherapy-regrets-why/ - ADT with EBRT and Brachytherapy https://connect.mayoclinic.org/discussion/adt-with-ebrt-and-brachytherapy/
See all: https://connect.mayoclinic.org/group/prostate-cancer/
https://connect.mayoclinic.org/discussion/brachytherapy-2/
If you are determined to have brachytherapy Then you need to go to a different doctor. UCSF Does offer brachytherapy.
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2 ReactionsHi heard him say in a video that he did sent use spaceOar for rectum. He
specifically said that. That is scary.
On Sun, Mar 15, 2026 at 9:28 AM Mayo Clinic Connect < nf+73decff2+106174883@n1.hubapplication.com> wrote:
> ## reply above this line ##
>
>
> Mayo Clinic Connect
> @jeffmarc
> < https://connect.mayoclinic.org/member/00-6018ad2132cc535a416722/;
> mentioned you in comment on Sun, Mar 15.
>
> *Message*
> @ambika
> My brother also was treated by Mack Roach.
>
> I know quite a few other people that have been treated by him in both the
> ancan.org Online advanced prostate cancer meetings, and the UCSF online
> meeting.
>
> While brachytherapy Is effective so is SBRT. SBRT causes fewer urinary
> issues than brachytherapy.
>
> There are several discussions related to brachytherapy for prostate
> cancer, including these: - Brachytherapy? Anyone have thoughts?
> https://connect.mayoclinic.org/discussion/brachytherapy-anyone-have-thots/
> - Immediate Side effects of Brachytherapy
> https://connect.mayoclinic.org/discussion/immediate-side-effects-of-brachytherapy/
> - Brachytherapy: Regrets & Why ?
> https://connect.mayoclinic.org/discussion/brachytherapy-regrets-why/ -
> ADT with EBRT and Brachytherapy
> https://connect.mayoclinic.org/discussion/adt-with-ebrt-and-brachytherapy/
> See all: https://connect.mayoclinic.org/group/prostate-cancer/
>
> https://connect.mayoclinic.org/discussion/brachytherapy-2/
>
> If you are determined to have brachytherapy Then you need to go to a
> different doctor. UCSF Does offer brachytherapy.
> VIEW & REPLY
> < https://connect.mayoclinic.org/notification/106174883/;
> ------------------------------
> Unsubscribe
> < https://connect.mayoclinic.org/email/unsubscribe/email-setting/;
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Your test results look just like what mine were just under 2 years ago, I decided for surgery, Dr. thought he got it all only to find out more was later found in lymph node so 6 weeks of radiation and 2 lupron shots , if I had it to do over I would have had radiation only , we are all different but friends within 6-12 months for their sex life back , I cannot get a good erection despite vacuum pumps, pills, and even injections. My marriage is not the same after 40 yrs and never will be I’m afraid, good luck to you regardless of your age
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Hug
1 ReactionYou are reviewing a lot of information in a highly emotional state. Over time, more information will come to the fore and you will be able to make an informed decision.
The most important step to take now is to locate a center of excellence. These are practices that treat a lot of prostate cancer patients. They will have the better doctors and equipment to help you. It sounds like you need to travel to get to these resources.
I say this is the most important step because doctors can give you wrong information! It is not good to have a treatment if another one is better.
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Hug
1 ReactionWhy is this community so awesome? Because there are so many people here who care and help. I say this as someone just beginning my own journey (surgery schedule for next month)
Here are quotes that I collected from just this one post (sorry, don't have attribution to who said what)
Lots of truth being spoken....
• Don’t let the numbers take you to dark places. With today’s medicine, there are solutions to each of them.
• Decision making; reads like a damned if you do damned if you don’t list…This is EXACTLY what prostate cancer is all about!
• Welcome to the Steep Curve Learning Club.
• “If you are getting poke & hope biopsies those are about as accurate as a bent arrow even though the prostate is mapped.”
• The PSMA PET scan is all important as it will tell if the horse has left the barn.
• Getting a cure in prostate is cancer unusual. Long-term remission is more common.
I'll just add a couple of my own thoughts that I've written down to try and keep myself in a better frame of mind (hah, I'm trying...)
"There will be more Valleys than Peaks. Stay strong.."
"Quality of life is more than just surviving. It is thriving, even if it is a modified version of the past. I guess you can joke that past performance does not guarantee future results, but we’ll take any results we can get. "
and finally, one last advice I'm telling myself.
"I think we have to give ourselves grace and just do what is necessary to get through the day. Kindness extends to ourselves as well."
Thanks to all of you out there! You are such a huge help to me in ways you can't imagine.
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3 ReactionsI will follow-up with my own post after a "Tele/Virtual-appointment" with my urologist on Wednesday, 3/18, but the main purpose of the appointment is to gain better clarity of my Cribriform glands tissue that was identified in my post-RP surgical pathology report.
I realized that I didn't know enough about Cribriform glands tissue and "why" it is thought to be so ominous of a feature identified in the surgically removed prostate. My reading discovered something completely unexpected: Some men have Cribriform gland tissue as a "normal" microscopic, anatomical feature of their "healthy" prostate. In other words, the presence of Cribriform glands in a post-RP surgical pathology report does not always mean there is a problem, even though some of us see it documented in our post-RP surgical pathology report.
The key factor seems to be whether there is Intraductal Carcinoma (IDC) identified along with the Cribriform gland tissue. I want a more firm understanding of this from my urologist because while I had Cribriform glands, I did not have IDC. That suggests to me that I may be a man with the presence of Cribriform gland tissue as part of what had been my previously normal, health prostate.
The additional shocker is that that there are several cellular classification subtypes of Cribriform gland tissue, each with its own level of interpretation and meaning as it "may" relate to your cancer. I found it amazing that the pathologist did not identify the subtype of Cribriform tissue that I had (my report just said "present."
My only guess is that, to a urologist and pathologist, it is automatically and clearly understood/inferred, like: 1) Cribriform Glands without IDC = no pathology related to the presence of Cribriform tissue; or...2) Cribriform Glands with IDC = cancerous pathology directly related to cancer of the prostate. And...if #2, then a a detailed description of the subtype of Cribriform gland tissue SHOULD ALWAYS BE INCLUDED IN THE REPORT. I thought that such subtype classification of Cribriform tissue deserves at least a footnote in the surgical pathology report, if not a thorough line item discussion.
Having been the Director of Clinical and Anatomical Pathology services for half of my career, I do realize that at times it is easy for us being on the "inside" of health care, to speak of things with the knowledge that the clinician with whom we are speaking or to whom we are submitting a written report, "understands" what is meant by what is "not said", or what is cautiously inferred by what "is" said. So, I am counting on my urologist to tell me in ultra-detail, what it means to have Cribriform gland tissue identified "without" IDC? Is the presence of Cribriform tissue still an ominous diagnostic predictive feature to my cancer, or...can I in fact be relieved knowing that without the associated IDC, I am - or should be - "fine." I'll let you all know by Thursday, 3/19.
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2 ReactionsWow, that is really interesting. I posted my biopsy and PSMA and the biopsy had two of 15 with cribriform 1 in LMM and 1 in RMM. Everyone from the PA, RO and surgical doctor just says that is bad. Nobody mention that this can be normal tissue, but after your post I think I read somewhere that cribriform can be in other places on a person and it's normal? Maybe that is why the are doing a decipher test??? Perhaps that digs into the cripriform tissue more? They are getting me ready for a RP, just waiting on decipher results which take 2 - 3 weeks. I need to ask this question. I did find this on a Google search or cribriform:
Diagnostic Challenge: Because this pattern ranges from benign to very aggressive, differentiating between them is crucial, often requiring specific staining to detect the presence of a basal cell layer, which is absent in carcinoma.
Makes me wonder if someone in Pathology was being lazy?
I know I had some questions on my PSMA as to why a spot on rib was not given a SUV score and doctor wondered same thing and was suppose to follow up, that been a week ago and noting heard back yet. The spot was so small it didn't show on CT scan. I wanted it biopsy, but they said to small to find it. All the PSMA report said was some weesel words "statistically reflects a benign entity such as fibrous dysplasia. Osseous metastasis is not entirely excluded. Recommend continued attention on routine oncologic follow up imaging. "
Also, wondered why they didn't give me values on blood, liver and parotid/lacrimal gland as I understand these are critical reference points because they naturally exhibit high physiological tracer uptake. Again doctor wondered same thing and was going to ask them to read PSMA Pet again. Shouldn't take them long, when I originally had PSMA Pet scan, they were done at 3:33PM and report was in MyChart at 3:55PM. Again a week ago today and heard nothing back on re doing the reading.
@rlpostrp
Actually, the cribriform That is a problem is large cribriform over .25 mm. The smaller cribriform that they do sometimes list on the biopsy is not really a major problem.
Was that discussed in your meeting?.
I could post a video from UCSF about the problems with large cribriform.
All mine said is large cribriform, no size. How can they measure it anyway, I seen the samples, they just look like little pieces if spaghetti. I guess they could go bu length if it was continuous. Seems they only way to really tell is after the RP?