PI-RADS 4 with ill defined margin and positive DEC

I have a PiRads5 lesion that is along the capsule wall.

Initial biopsy in Sept 2025 (after MRI) was Gleason 3+3.

Just did another MRI and Biopsy within the past week.

Waiting on those results.

Surgeon/Urologist at City of Hope, that I have been seeing after initial MRI and Biopsy was completed at local small hospital, indicated MRI’s are pieces of information.

Biopsy will provide better information and add to the info from the MRI.

PSA, MRI, Biopsy, Decipher, PSMA PETscan, etc are all pieces of information.

Do not stress too much, just on the MRI. For me, the MRI confirmed I needed a biopsy.

As far as TULSA, I was not a candidate based on location of lesion. Dr Scionti reviewed my MRI and Biopsy and indicated TULSA was not an option.

Best wishes on obtaining more information

@keithl56
I did not have your exact symptoms but when you get a biopsy, make sure to get the decipher test done from your biopsy sample. It is used as a component by the doctors and can can change treatment options.

Exact same here - PI-RADS 4, lesions, 165cc size. I have not had a biopsy. Probably won’t get one. Check out Dr Emberton on UTube. He gives you the education that anyone is much needing when facing this issue.
Search on Emberton Prostate Cancer.
There are several.

@charlesprestridge

Thanks, Good luck and keep me posted as to your progress.

@csbarry

Thanks. Why no biopsy? Are you choosing to just do active surveillance?

@bens1

Thanks. I'll make sure to request the Deicher test at my appointment this week.

@keithl56 Ask for the Fusion guided Transperineal biopsy. Much more accurate and less chance of infection.

Unfortunately, my urologist only does fusion guided transrectal. At least they use twilight sedation.

@keithl56
Dr Emberton explains that it is overused and the side effects aren’t worth the process. Even at PI-RADS 4 I will probably die of other issues before cancer. I am 62 - PSA was 9.7 last year and 8.6 this last quarter. My next will be in Aug and I will make some decisions then. If I am over 12 then trouble is coming.
My surgeon wants to scoop my prostate out - which will leave me incontinent, with no erection or able to produce any seminal fluid. His answer is to give me a penis pump or his office can show me how to inject my penis with trimex. LOL No thanks. I will play the long game and hope for the best. In the meantime I will continue to enjoy my sex life as it is - I will savor every minute.

I had a PIRADS 4 lesion that obviously was the concern. I went into my biopsy and they took several specific bites of the apple and then did the basic template random dozen bites. When I went to see my Urologist afterwards for the info, he told me he had good news and bad news. The good news was the PIRADS 4 lesion was benign ( the purpose of the biopsy) which surprised him, but then the bad news, the random cores identified two Gleason 6, two Gleason 7 (3+4) and one Gleason 8 (4+4). He did explain to me a concerning PIRADS lesion can come out benign. It was fortunate their was a PIRADS 4 that hastened my probably future biopsy later down the line when symptoms may have gotten worse and the cancer left the capsule