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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
I have heard from a lot of people that have had radiation, I had salvage radiation for 40 sessions. Very seldom hear about problems with Bowel urgency/blood. It may occur in a few cases, but it is not a common problem. I’m over 10 years past that radiation and the Only problem I have encountered is incontinence That started six years after radiation and nine years after surgery.
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1 ReactionWell, I spent 38 minutes and 42 seconds on phone being transferred all over KUMC trying to get appointment with Dr Parikh and then ended up at a voice mailbox. Just unbelievable, I was transferred 7 times! Wife got upset and called patient advocate, but got voice mail after around 10 minutes or so. I called my nurse navigator and got voice mail. I have left her voice mail before over the last months and she don't call back. However, today she called back. She said Dr Parikh wouldn't see me, he only see patients that have cancer that has spread or need hormone treatment. Also, made some other calls and end up getting voice mail after listening to long options on pressing this number or that number. Total time, 2:30-4PM and end up with he don't take someone in my status.
This is KUMC ranked cancer center by all the rankings very high. They were great for breast cancer- couldn't have been better. However that was in 2019. Did get some questions answered via MyChart from RO herself, which was good. Surgical doctor nurse did call, but didn't really answer questions, but would find out and call back. She thought it strange I would want appointment to talk.
Still leaning toward removal, but could get that done locally by Dr Rupp who has done lots of them. All depressing, was hoping for same kind of response wife got in 2019 at KUMC. Sorry, I am rambling.
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1 Reaction@diverjer
I’m a little surprised that with all the large cribriform They are not considering putting you on hormone therapy after treatment. Usually, if somebody has radiation, they do put you on hormone therapy after, even with 4+3, If there are aggressive issues.
I guess you’ll have to see what the doctors say.
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2 Reactions@diverjer
Yes, both methods have pros and cons unfortunately : (. Radiation can cause immediate discomfort (so called early toxicity) and also late toxicity that happens couple of years down the road. Late toxicity is more dangerous since it tends to linger and can become actually worse over time.
Radiation damages healthy tissue and inflammation and mutations that happen in healthy tissue degrade more and more over time. That is why incontinence of a bladder and colon can appear and happen down the road as well as ED.
What your friend described was a damage to urethra - it can harden and it also can constrict and make urination difficult due to formation of scar tissue.
Radiation also effects processes of blood production and can cause anemia or low white blood count which effect immunity.
About 15-20 % of patients develop late toxicity grade 2 (mild to moderate) and about 2-5% grade 3 (severe).
ADT brings the whole another set of side effects.
All in all - unfortunately there is NO method that does not have some risk , it is just the matter of how you personally feel about the whole process and what looks less scary to you at this particular moment in time.
Wishing you all the best and sending good vibes for your medical team to respond better and faster - my husband went through tons of delays and calling around and he was also treated in top cancer center : /, so I understand your frustration : ((.
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5 ReactionsThat is what is strange, the RO was going to use ADT, I am not a doctor, but would consider ADT hormone therapy. I guess she meant cancer spread AND on hormone therapy? Notes from the actual RO doctor below:
I would still recommend hormonal therapy if you choose to undergo radiation therapy. I don't anticipate that the ADT will worsen your PVCs. We could always do the pill form of ADT, relugolix, rather than the injection (lupron) if you are concerned about your heart as it on studies has a better cardiac profile.
Logistics of treatment for radiation and ADT would be to initiate relugolix, approximately 1-2 months after starting relugolix we would place the markers and the gel and start with radiation therapy a few weeks after this for 28 once daily treatments, approximately 5.5 weeks. You would continue with relugolix after completion of the radiation therapy and then complete the remaining amount of relugolix for a total of 6 months.
Radiation bowel urgency, if it occurs, typically would happen toward the end of radiation and last for up to several weeks. This gets better with time. It is not typical for bowel urgency to become a chronic issue after radiation.
Blood in the urine or stools is possible 1-2 years out from radiation therapy. This is a long term side effect caused by development of telangiectasias (small, more fragile blood vessels) which do not occur until a year after radiation therapy. The bleeding occurs in approximately 2-10% of men. Typically, the bleeding is self limited and resolves.
From what I can tell Jeff, it looks like you and Phil had RP first? Surf, I am not sure what I think your spouse did first?
I am still leaning toward surgery, if I do have long bad incontinence there is always something called urethral bulking or mesh sling that might help. Seems they could spare nerves on right side as those 3 prostate lobes were benign (shows that in my first post). MRI showed Prostatic capsule: Intact, Neurovascular bundles: Not involved, Seminal vesicles: Not involved, Lymph nodes: No lymphadenopathy, Bones: No acute osseous abnormality. Still I guess they worry about microscopic issues that MRI wouldn't get.
Thanks for all your suggestions and responses, I know I ramble on and don't type that well. Hopefull, makes some sense.
@diverjer
Yes, I started off with surgery and 3 1/2 years later it came back and I had radiation for about eight weeks.
Your doctor wants to put you on hormone therapy if you’re having radiation. You might contact Dr. Parikh’s Office and tell them that, Also, the fact that you’ve got large cribriform, Which implies you may have a reoccurrence no matter what’s done.
You can Avoid the bowel problems by getting a barrier put in something like SpaceOAR, Barrigel, or BioProtect. Those can protect the rectum from damage during radiation.
While surgery sounds like it can do a complete job people do have problems with incontinence after. You really should be prepared for that and be doing Keagle’s ahead of surgery and plan on having physical therapy sessions with a pelvic floor specialist after. I got over surgery very quickly as did @surftohealth88 Husband. I was back at work full time seven days after surgery. The day after surgery, you usually only need Tylenol for pain and the scars heal very quickly, And disappear. ED After surgery, Even if they can spare the nerves, Can take months to a year or two get the erection back. There are some really good solutions if it doesn’t work.
If you have surgery and the urinary blockage is in the prostate, then that problem will go away. Yes, the sling is a possibility but if you need to have radiation after surgery, the sling will not work for you in the long run. You can get an AUS if you end up having to need radiation. If you don’t ever need radiation, the ProACT device probably is better than the sling. I don’t think there’s any guarantees you will not need radiation in the future if you have surgery.
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1 Reaction@diverjer
My husband had radical prostatectomy.
You are not "rambling"- It is all very overwhelming, especially at the begging : (((. So much to learn and digest and all of that combined with feeling of utter panic and fear and feeling of helplessness, especially when scheduling becomes a problem and one feels like a "hot potato" tossed around. Just keep in mind that whatever you choose is a good choice in regard of attacking and possibly eradicating cancer. Studies sometimes show RP is doing a better job , some studies show RT does a better job - but they ALL do a pretty good job in controlling this obnoxious disease. At the end it all comes to one's personal choice and to what is making one feel more comfortable doing.
My husband had consultation with surgeon and with radiation specialist since his doctor insisted on that , but from the beginning he was more comfortable with surgery idea. Some people are more comfortable with RT idea and they try to avoid surgery any way possible, and that is absolutely OK !
The only mistake one can make is of NOT doing anything. All other options are good and have great potential to be very successful.
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5 Reactions@diverjer Don’t know his particulars, but NOT having the proper bladder/rectum protocol is a HUGE no-no!!
No wonder he wound up needing his urethra grafted…that SE is rare when proper protocol and preparation is followed.
Phil
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2 Reactions@diverjer
The symptoms you describe are common with effective ADT.
With a radical prostatectomy, it is not uncommon to be left with impotence and urgency I continence.
RT can result in bladder and bowel maladies.
Once you decide on which therapy you desire and the consequences after, you must follow your PSA every 3 months for 1 year and depending on the results, every 6 months recognizing it may not be zero as a small amount is produced by some urethral cells but what is more important is the level and the course.
Best of luck with your decision.
Dr. B
Well I made a decision! I just got tired of dealing with KUMC even though it's a NCI-designated Comprehensive Cancer Center. I went to a local clinic in Topeka. I know DR Rupp and he has done Urolift and treated me for BPH for years. So I do know him and his background and he knows me. I also know he has done thousands of RP with the da vinci surgery system. Also, did some major surgery on my father-in-law many years ago. So he does have the experience and seem positive today for surgery. Did mention radiation as they also do that, but I wanted surgery and he agreed.
DR Rupp has all my test results from KUMC and he thinks he should do some nerve spearing- not all. Can do more sparing on one side than the other, somethings about the percentages and the outside 3 lobes on right were all benign. Also, didn't think connecting to bladder after Aquablation would be as big of a problem as KUMC doctor. Said he had done many RP after TURP and it does cause some challenges, but not anything that he hasn't had success with.
I haven't burnt any bridges with KUMC, didn't chew them out or anything. but sure was not happy with them and communication was terrible. So I at least got tested and given options at a NCI-designated Comprehensive Cancer Center and they pretty much agree.
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