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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 cannot understand why they pulled the JP drain so quick. A Jackson-Pratt (JP) drain following a prostatectomy with lymph node removal is typically pulled when output decreases to 30 ml or less in 24 hours for two consecutive days. That’s according to UC Davis Health
This really does sounding like incompetence and insurance Malevolence. Why are the doctors letting you go so soon when this thing should be in so much longer and you are not doing well.
I’m sure many of us are angry about this situation.
I sure hope you recover without having to go back to that emergency department again.
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3 ReactionsDoctor gave me excuse. 1. Staying hospital you are likely to get infection. 2. Some of his patients go home same day. 3. I done over 2,000 of these, you don't need to stay.
Really made me mad, I really wanted to chew him out!. It clear there was a problem and this was not normal. Doing 2 RO surgeries within 12 hours, one at 2 AM. Two and one half surgery, ended up took more that 4 hours. It was amazing how the nursing staff felt the same, they had to fight to get him to come in when a second surgery was done. Then the nursing staff told me not to leave on Friday PM, they told me how to file some forms- but that ended up not being necessary, but doctor didn't like it and kind of call me out on it.
Running 100.2 fever now. I have only rook 1 of the hydrocodone 5 mg. In a lot of pain, but also stopped up and afraid that will make worse, so dealing with lots of pain. Maybe that is stupid?? Still having red urin and a few clots in bag. Think that is pretty normal, actually less than the aquablation.
Doctor said first surgery took so long as bladder neck was a mess from the aquablation done by a resident 2 years earlier. Said I should be peeing a lot better as he fixed it. Long story on thr resident doiong surgery at KUMC without my okay.
Also, a whole lot of pain is from that inguinal hernia being repaired that I didn't want!!! I knew about it, had it forever and never bother me. I tested it every now and then it never got worse. I been told I could sue him for doing surgery not on the list and one I didn't want. But for now I need to just get through this and see what will be end results. Pathology won't be known for few days hopefully this week. My doctor is leaving on vacation on 7th.
Hope this makes some sense, pain is terrible and brain not function that well.
One questions, not trying to be gross but wonder. Had anyone else that had ROPR have their testicles swell up as big as baseballs and turn black. Also penis has turned black. Testicles are so big you can hardly see a penis. It is very painful almost as much as rest of area. Maybe this was from the surhery he did I didn't want or maybe this happens with just a normal ROPR?
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2 Reactions@jeffmarc
Very true my daughter and floor nursing staff said same. Doctor said maybe for heart area, but I would absorb it in gut area.
@diverjer Oh man, so sorry for all your grief! I am a little confused: after your prostate removal, the second emergency surgery was for the inguinal hernia?
If so, could it be possible that the first surgery caused strangulation and that caused the fever, etc? It’s an odd situation but I think you need to know more about the WHY of your emergency surgery.
I don’t know the actual percentages, but there is an issue with RARP causing inguinal hernia, so if you already had one, surgical manipulation might have caused it to become entrapped somehow.
Hope you feel better soon!
Phil
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3 Reactions@diverjer
Don’t think black is good. Don’t hesitate to return to ER, especially with your Doctor leaving on vacation.
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2 Reactions@diverjer
I hope by black, you mean, black and blue. A black organ could mean it is strangulated and has no blood and could actually fall off or cause of major infection.
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2 Reactions@heavyphil
No they did the inguinal hernia on first surgery. I didn't want that done, but was never asked as I was out. I have had that inguinal hernia for decades and PCP and I both said it wasn't that bad. Never bothered me, I would check it my self and it never got worse. And believe me I lift a lot of heavy things. Surgeon seen it and just decoded on his own to repair.
I believe the second surgery was bleeding issues that need ed stopped. I am still bleeding what I would expect into bag, at times. Sometimes yellow, at moment red. While at ER I noticed it went down a bit to 9.5 when I left hospital it was 9.6. So I am not making as much as losing!!!
It not as black as my keyboard, but close. Also, much darker than big bruise on my left hip whice happen somehow during all this surgery,
@diverjer
I had a inguinal hernia for 13 years before my surgery. I had read stories similar to yours where once the surgeon was inside he discovers the hernia, unaware that it was their and proceeds to repair it. He may have thought you were not aware of it. I had been for two consultation’s on my hernia over the years and they have never advised me to watch and wait, they and I think all surgeons express the surgical opinion that things can south real quickly with a hernia and become an emergency if to become strangulated. Mine was discovered on a routine update CT for my non Hodgkin’s lymphoma. It was just to me one of those extra findings and my oncologist never mentioned it. Three years later it was their again and I think I asked about it. So by that time I had gone three years with no issues and it was small so I ended up not doing anything. Years later in a conversation with my GP who wanted to do a hernia check and I mentioned it to him now about 7 years with it, he was insistent that I get a surgical consultation because of it. I saw the surgeon who although I had it for years was it needs to be fixed and when I pressed him like I had it for 7 years it’s possible nothing changes for another 7. He said yes, but and then gave all the dire warnings about lifting something too heavy having and exacerbating into an emergency. Well I just never went back. Now when I went into my surgical consultation for my prostatectomy I mentioned my hernia and did not want anything done unless it was absolutely necessary and my surgeon told me that he would not even consider adding another surgical procedure regardless and hernia repair was not his expertise and would not really want to do one. He said after surgery healing and recovery he would refer me to someone then. Almost two years later still have not done anthology
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2 Reactions@wheel1 I'm glad your hernia is still doing well, I think the surgeons just get too excited and see an easy fix to make a little extra money. I know mine wasn't bothering me and it's easy to check to see if it's getting worse I can do it myself. Actually, the results of what I believe for the hernia part where my balls are swollen up and you can hardly tell I have a penis and it's really black, I don't think I see any blue in it but I don't know. I compared it against my black keyboard and it's almost that dark. I'd post a picture but I don't want to gross everybody out. I don't know if I can but after this is all over I'm thinking I might want to sue this guy, and maybe for some other things that seem like errors? Hope your prostate surgery goes well.