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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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Wife and I went to the fitness center we have a membership to this afternoon a few hours after doctor's appointment. It was pretty windy today, so decided to go to center and do treadmill as well as weights. We do at least 2 miles a day walking. If it's nice we walk outside, but windy today. Besides, do weight workout several times a week. Our fitness center is different than most, if we go check in 12 times a month we get a big reduction in price. If you don't go 12 times a month, you pay full price. Only started this when we moved to town and I didn't have all the chores of taking care of livestock and acreages.
On way to the fitness, I got a call and surgery date was set already for May 7th. Seems I need to fill out a bunch of forms and have a visit with my primary care doctor for the surgery. Seems they want his input on my health etc.
What was strange while at fitness, I seen my surgeon Dr Rupp. He was there working out on weights also, says he goes a couple times a week. So we had a nice little visit, but kept medical stuff out of conversation. Thought that strange that I seen him there a few hours after appointment. Most likely I have seen him there before and just never noticed. Once, I walked by our daughter at a Walmart and didn't know it until she grabbed me. I been told I do that a lot.
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1 ReactionWell, now someone mention something called TULSA Pro, anyone ever hear of it and think I would be a candidate? Sometimes I think I should stop talking to people about this?
Your biopsy shows PCa far more extensive than any good Dr. that does Tulsa Pro would accept. That would be okay if 1 or 2 intermediate lesions. This has a higher failure rate than surgery or radiation.
@diverjer
There are a lot of people in this forum that have talked about their Tulsa PRO Experience.
If you go to the top level of the prostate cancer forum, you can do a search for Tulsa PRO And you are fine many people talking about it.
Here is some more technical information about Tulsa PRO
https://tulsaprocedure.com/find-a-tulsa-pro-center/
https://tulsaprocedure.com/
If wondering about Tulsa Pro from a science point of view, here is a basic Tulsa science overview article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231661/
Go here and compare your probability of cure vs the major treatment pathways
https://www.prostatecancerfree.org/compare-prostate-cancer-treatments/
Don’t use cellphone use a computer.
There are 3 graphs, one each for low, intermediate, and high risk. Sounds like you might be high? (Risk of recurrence after treatment).
The elipses can be confusing. I put a dot on each eclipse and drew a line to make it easier to intemperate. If you need help readin the charts get it.
You will notice that chance of cure starts well for RP (removal) but drops as risk increases. At high risk you are down to 40-50% chance of cure.
Compare that to radiation options.
Get Dr Scholz book where you can stage yourself.
You need to learn to survive.
This zone is flooded with bad information. You will hear different stats from every damn doctor. Im sorry but the cancer is not the most dangerous thing here. Getting steered wrong is just as deadly.
Read read read
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1 Reaction@jeffmarc Saw radiation oncologist today. My husband was reading orders incorrectly. Lupron was there if Orgonyx was too expensive. So, thanks Jeff. He will not be getting Lupron injections.
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1 ReactionThese people at KUMC are driving me crazy. I should have never asked this question, but I thought what the heck see what a national cancer thinks. I asked about getting the TULSA and this is the reply:
Dr. Duchene response says that you would not be a candidate for focal therapy, like HIFU or TULSA-PRO, because you have high risk prostate cancer.
Now why they are driving me crazy is the PA-C said in clinical notes+++> Re-discussed staging with Jerry--> cT1c; Unfavorable intermediate-risk prostate adenocarcinoma. No mention of high risk!
Then RO said Stage 2B prostate cancer is a localized, intermediate-risk cancer confined to the prostate gland, affecting more than half of one side or both sides. Again, no mention of high risk!
Some other notes from surgeon (Dr Duchene) have called it clinical stage cT1cN0M0 (which is not high risk- it's intermediate), but then as a side note he says: Biopsy confirmed extensive grade group 2–3 prostate carcinoma with 2 cribriform glands (which actually puts him in a likely higher risk category -- high risk prostate cancer), clinical stage cT1cN0M0.
In the same sentence he says, likely higher risk category -- high risk prostate cancer and then says cT1cN0M0 which is intermediate-risk.
I am still sticking with local guy for RP on May 7. Shouldn't have asked the KUMC surgeon. My guess is officially I am intermediate-risk, but with the 2 large cribriforms unofficially I am high risk.
@groundhogy
Thanks, I looked at it, but need to take more time to study it, pretty confusing. And it keeps popping up people donating money all the time in lower left of screen. Seems like a lot of donations or they are just doing that to get donations? Also one icon says RP surgery and another says Robot Surgery. I am guessing RP surgery is just open surgery and not robot which i didn't think anyone even did anymore? I would think all RP would be done with something like the Da Vinci system.
@diverjer
It really comes down to that large cribriform. That makes it very aggressive and eliminates focal therapy as an option. It can be very difficult to eradicate even with surgery or radiation.
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2 Reactions@jeffmarc
I think that is right, those 2 large cribriform in center (LMM & RMM) unofficially jump the score up 1 point. Even though officially they call it unfavorable intermediate. The whole scoring system for prostate cancer seems to be a mix bag.
The doctor here in town (DR Rupp) that will be doing surgery seem to talk some about involving percent of needle core tissue in each biopsy, which nobody had mention before.
He has couple thousand RPs under his belt with the Da Vinci robotic system. Our daughter has been floor RN 12 years at hospital I will be at (she is just a few months of finishing up her APRN) says patients are pleased with his results. Also, said the staff like him and think he is funny. I thought beside having the experience, it was nice the nursing staff liked him.
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