Not Good News after prostate biospy when MRI didn't look too bad

Posted by diverjer @diverjer, Feb 10 9:29pm

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.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

heavyphil | @heavyphil | Mar 31 6:15am

In reply to @diverjer "@jeffmarc I think that is right, those 2 large cribriform in center (LMM & RMM) unofficially..." + (show)

@diverjer Regardless of what they’re calling it, the procedure should be the same - remove the gland, some nodes.
The surgeon, based on what he sees and what he knows about your biopsy findings, will probably pay careful attention to the capsule and surrounding tissue since that’s where cells can sometimes be found outside the gland.
I would hope (?) that no surgeon goes into a procedure cavalierly thinking “Oh, this guy only has intermediate cancer, not high risk…I don’t need to pay attention.”
Phil

diverjer | @diverjer | Apr 27 3:45pm

Well this just gets me more depressed and anxious.
Seen a local RO as suggested, so that if margins had positive results from Thursday ROPR, I would have someone near to address the issues. Nice RO, he spent about 45 minutes with me.
If you have read prior post, you will see way back in Feb 27, the National Recognized Cancer Center (KUMC) said there was a spot on 5th rib that showed on PSMA Pet, but was not visible on CT. KUMC said get another CT in 3-4 months and see if it can seen. Had MRI that said all was contained to capsule. Decipher test not good was .85. Genetic test was just okay was one variant uncertain significance (VUS). Overall unfavorable/intermediate. Two of the doctors at the National Recognized Cancer Center they believe there was zero chance that 5th rib was from the prostate cancer and don't worry about it. Anyway, after trying to get surgery scheduled at KUMC for weeks and no response, I came back to Topeka at a urologist I know. He has me scheduled for surgery this Thursday PM using the DaVanci 5 Robotic System. He says he has done over 2, 000 prostate removals. I guess from what I hear the DaVanci 5 is one of the newer ones and he says it better that the older one. No time yet for Thursday procedure, won't know time until Wednesday sometime (the fun prep day). Just know it will be in afternoon.
Anyway what I found a bit depressing is the RO today said I should have had the CT scan to double check the 5th rib again prior to surgery. Said if it was showing up now on new CT scan, there would be no use for surgery. Other treatment would be done. From my understanding if it has spread, nothing will work anyway?? I am just toast. Well it's a little late to get a CT scan!! Then I have the 2 KUMC docs that said zero chance 5th rib lighting up on PSMA Pet was from prostate cancer. But RO I seen today said he has seen it skip from prostate up to areas like 5th rib or collar bone with nothing showing in between.
Then RO today says if I have positive margins (after surgery) they will have to wait 4 - 9 months before radiation and ADT as things need to heal up prior to radiation treatment. That seem odd, just let the cancer spread 4 - 9 months while healing up from surgery.
I left wishing I had never gone to that appointment. He was very nice, just didn't like what he was saying. Be a lot easier just dropping over dead with a heart attack.

wheel1 | @wheel1 | Apr 27 4:45pm

Sorry to hear of your results. I imagine they order a PET scan next to check for any spread. I think at your age radiation plus adt is the standard of care. You don’t hear too many above 75 that get slotted for surgery, but there are exceptions. Your urologist will certainly refer you to a radiation oncologist. I would recommend that regardless of your outcome of your appointment with the radiation oncologist for your own benefit obtain a second opinion from another RO.

diverjer | @diverjer | Apr 27 6:44pm

Well surgery is Thursday, so no scans until after surgery and the pathologist do all the microscopic of prostate tissue and check margins.

heavyphil | @heavyphil | Apr 28 6:12am

In reply to @diverjer "Well surgery is Thursday, so no scans until after surgery and the pathologist do all the..." + (show)

@diverjer Yeah, that sucks! Like @fritzo, who watched a TulsaPro promo a few days before his planned surgery and got himself worried sick about his decision.
I remember your rib situation - since I had a similar lesion on my hip which was deemed not to be spread of PCa.
Also, I don’t remember your PSA but my RO said that a bony lesion would produce much higher PSA values.
And yes, they’ve now found that PSA can stay low in the presence of radiographic spread, so more confusion, right?
Your RO, citing that clavicle lesion, really didn’t do you any favors…that is an often cited - but rare! - case which validated the usefulness of PSMA PET scans, so don’t think it happens every day cause it doesn’t.
Good luck on your surgery!
Phil

charlesprestridge | @charlesprestridge | Apr 28 7:18am

In reply to @diverjer "Well surgery is Thursday, so no scans until after surgery and the pathologist do all the..." + (show)

@diverjer

Best wishes on your surgery and recovery.

We will be thinking of you on Thursday.

fritzo | @fritzo | Apr 28 9:25am

In reply to @diverjer "Well this just gets me more depressed and anxious. Seen a local RO as suggested, so..." + (show)

@diverjer

Jump to this post

@diverjer I'm so sorry you're going through all of this. It's really, really hard. I don't know all the medical stuff, I just know that not knowing what is the right treatment for me but wanting to make the right decision and for it happen right now is brutal.

Just know that we are all out here rooting for you. So many people on this forum have been through the worst. I have a good buddy who was diagnosed Stage IV in 2020. He's had Focal, RP, RT and hormone therapy. It was tough and he had some dark days. But, he is the happiest guy I know, doing amazing things with his life and his cancer is now undetectable. There is light at the end of the tunnel....it just sucks to be in the tunnel. Hang on the best you can. Spill your emotions here-we're here to listen and support.

diverjer | @diverjer | Apr 28 10:41am

Thanks everyone for the well wishes. Lots of folks are praying for me and wishing all goes well. And I am thankful for them all! I know that you guys know first hand what it's like to go through this situation.

diverjer | @diverjer | May 3 6:36pm

This update may not make sense, not feeling good and been a rough few days.
Had ROPR surgery 12:45PM on 30 of April, lasted longer that plan, finished after 4PM
Sent to room, later in night nursing staff very concerned, four of five in room called doctor and they called in surgery team and another surgery less than 12 hours after first surgery, 2AM Friday May 1 morning. It took over 2 hours.
Doctor wanted to send me home Friday PM May 1. My JP bulb was putting out 400 ml since last surgery and nursing staff said I shouldn’t be leaving that soon after 2 surgeries and all the blood being sucked out into JP bulb. Told me to refuse.
Got out Saturday afternoon May 2 at times my BP low number was 45. My blood count was down to 9 and it was 16 something when I had test prior to surgery. Even when they pulled the JP bulb, I did about 400 cc since midnight, they puilled it anyway. Doc said body would absorbed it. Nurses didn’t like that and my daughter APRN said they usually wait to pull JP until down to 25-30 a day. Nurse on floor said same thing.
Woke up Sunday with fever and told to go to ER, spent 5 hours getting lots of things checked and told to go home.
Then without me asking on first surgery he put in mesh on a inguinal hernia. I knew I had this hernia for last 30 years and I didn’t care. Wanted it left alone, I would check it myself every now and then and it never got worse or bothered me. Not happy about that. My balls are big as baseballs and black and hurt, penis id also black! Balls are so big you can hardly see I have a penis.
I am in misery!

charlesprestridge | @charlesprestridge | May 3 8:33pm

In reply to @diverjer "This update may not make sense, not feeling good and been a rough few days. Had..." + (show)

@diverjer

Wow, so sorry for your issues. I don’t understand them sending you home so soon. I hope you are able to make some healing progress this week.

Hard to understand Doctors not having more regard for a patient with that much blood loss. Blood count below 10 and BP getting that low is not good.

Best Wishes.

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