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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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Read the article:
Active Monitoring, Surgery, and Radiotherapy for Cribriform-Positive and Cribriform-Negative Prostate Cancer
A Secondary Analysis of the PROTECT Randomized Clinical Trial
Nikita Sushentsev, MD1,2; Anne Y. Warren, MB BS3; Richard Colling, MD2 et al
JAMA Oncol
Published Online: October 16, 2025
2025;11;(12):1512-1517. doi:10.1001/jamaoncol.2025.4125
related icon Related Articles
Key Points
Question What is the long-term incidence of metastasis in patients with cribriform-positive and cribriform-negative prostate cancer who undergo active monitoring, surgery, or radiotherapy?
Findings In this secondary analysis of the 15-year outcomes of the PROTECT trial, the cumulative incidence of metastasis was 25%, 26%, and 8% for men with cribriform-positive prostate cancer assigned to active monitoring, surgery, and radiotherapy with neoadjuvant androgen deprivation therapy (ADT), respectively. For men with cribriform-negative disease, metastasis occurred in 7%, 4%, and 3% in each group, respectively.
Meaning These findings suggest that patients with cribriform-negative prostate cancer are at low risk of long-term metastasis regardless of baseline treatment, whereas patients with cribriform-positive prostate cancer are at high risk of metastasis that is potentially reduced in those receiving radiotherapy with neoadjuvant ADT.
Abstract
Importance Cribriform prostate cancer is associated with poor outcomes; however, its optimal treatment strategy remains unclear in the absence of randomized data.
Objective To retrospectively analyze the results of the PROTECT randomized clinical trial to establish the association between cribriform-positive and cribriform-negative prostate cancer and 15-year risk of metastasis in patients who underwent active monitoring, surgery, or radiotherapy.
Design, Setting, and Participants Between 1999 and 2009, the PROTECT phase 3 randomized clinical trial enrolled 1643 men with clinically localized prostate cancer who were randomly assigned to receive active monitoring, surgery, or radiotherapy with neoadjuvant androgen deprivation therapy (ADT). In this secondary analysis of the PROTECT trial, a centralized histopathologic review was conducted on available diagnostic biopsy slides to classify patients as cribriform-positive if they had invasive cribriform carcinoma and/or intraductal carcinoma. Data were collected from January 25, 2024, to October 11, 2024, and were analyzed from October 14, 2024, to January 30, 2025.
Exposures Age, prostate-specific antigen (PSA), Gleason score, and cribriform status.
Main Outcomes and Measures The primary outcome was progression to metastatic disease (bony, visceral, or lymph node metastases on imaging or PSA >100 ng/mL). Multivariable Cox proportional hazards regression models, adjusted for randomization variables, were incorporated to assess 15-year metastasis risk. Cumulative incidence curves were compared using the Gray test. Both intention-to-treat and per-protocol analyses were performed.
Results Among 712 men (mean [SD] age, 62.0 [5.0] years) whose biopsies were retrospectively reviewed, 93 (13.1%) had cribriform-positive disease and 42 (5.9%) developed metastasis. In the intention-to-treat cohort, cribriform-positive disease significantly increased the risk of metastasis (hazard ratio [HR], 3.61 [95% CI, 1.60-8.11]; P = .003). Radiotherapy with neoadjuvant ADT significantly reduced metastasis risk (HR, 0.35 [95% CI, 0.16-0.78]; P = .04) (15-year cumulative incidence in patients with cribriform-positive disease, 8%), while surgery delayed metastasis but did not significantly improve long-term outcomes compared with active monitoring (HR, 0.52 [95% CI, 0.25-1.08]; P = .09) (15-year cumulative incidence in patients with cribriform-positive disease, 26% for surgery and 25% for active monitoring). Among patients with cribriform-negative disease, incidence of metastasis was low and did not differ by treatment. Similar per-protocol results were noted.
Conclusions and Relevance The findings of this secondary analysis of the PROTECT randomized clinical trial suggest that cribriform morphology was a strong, independent predictor of 15-year metastasis among patients with prostate cancer and that radiotherapy with neoadjuvant ADT was associated with a reduced long-term risk of metastasis. Conversely, outcomes were favorable for most patients with cribriform-negative disease, supporting their eligibility for active surveillance.
Also see the videos of Dr. Shultz in YouTube among them:
watch?v=HEAEmFDOlfQ&t=5s
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Hug
4 ReactionsYes there is a lot in there to study. I got a 5 minute phone call right as doctor was going out door on vacation. I knew he was going, thought he already had left. His didn't sound that concerned, said check PSA in 3 months. His APRN will remove Cath Tuesday. Will make appointment with him to discuss report.
I will do that test in 3 months, but have additional things planned. Already have an appointment with local oncologist on May 27. It's a 1 hour first visit appointment. Will go over report with him.
Then will also tomorrow make appointment with the RO at KUMC. I always got along with the RO at KUMC (a national center of excellence). It was the surgical area at KUMC I had problems of not getting responses for weeks if at all. The RO doctor would respond within hours and she would actually respond herself many times and not just tell the RN to reply.
My thoughts are, why not let things heal up, then start ADT and radiation now- not wait for PSA to rise. But between the visits with local oncologist, local surgeon and KUMC RO, I will have more information.
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5 Reactions@diverjer Sounds like a plan. That surgical report is kind of contradictory but Jeff explained the difference between lymph gland invasion and lymphatic spread within the gland.
But the seminal vesicle invasion and the presence of PCa on the surgical margin are things to be concerned about.
You will monitor the PSA and take it from there, unless your very first one shows something more than ‘undetectable’.
The you’d want to contact that RO.
Hey, has your bleeding subsided? Stopped? Hope so!
Phil
The Non-focal extraprostatic extension is present" and lymphovascular invasion, are concerning.
Also the < than 3mm cancer margins?? Is that saying the margins were positive for 3mm around the entire prostate? Then maybe the statement Focality of Margin Involvement: Unifocal means one location had the < 3mm?? I don’t know!
Percentage of Pattern 4: 31 - 40% indicates that roughly one-third to nearly half of the cancerous tissue in a specific sample is composed of Gleason Pattern 4, which is more aggressive .
But then is says 11- 20 percent of prostate had a tumor, so that sounds better and maybe that is where the pattern 4 is- in that 20%?
So I have lots of questions like that that need to get answers. But will be awhile, maybe on the 27th ?
Still bleeding, tube full red right now. Already lost lots of blood from normal surgery then that arterial bleed they found at 2AM 2nd surgery had been pumping for 10 hours. Ask for hemoglobin blood test yesterday and when I looked for results, seen they sent in A1C test of all things. I am not diabetic. Today I asked them to send in the correct test I ask for and they refused! I chewed them out and hung up. They called back later and said they would send in the requested blood test and come in and see the APRN at 2PM. Doctor is on vacation and staff seems confused and not to happy.
I just don’t feel well, sometimes have small fever, can’t set or anything without pain, balls still are great big and black and blue, can’t see penis and it hurts. Using ice that helps some. The 6 holes and stomach area are not too painful. Just black and blue from one hip to the other. .
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1 ReactionWell went to see APRN and now they believe be as they seen blood and that is was dark red and even seen a clot. Also, looked at testicles and seen how big they are and even covered up penis. She, the APRN, said if looks like that on Tuesday, I don't think I should pull catheter. I thought OH NO. Told me to buy some iron pills and drink some kind of stuff, Boost or Insure. One good thing blood came back to 10.1, was 9.3. So I am making more blood than loosing. Hopes she can talk to doctor before Tuesday, he is on vacation in Greece, but sometimes calls in.
The APRN just couldn't believe all the bruising. She said it over and over and been in that office 6 years.
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1 Reaction@diverjer
You have so much more bruising than anybody I have ever heard of.
I hope this doesn’t lead to any problems, And you just recover.
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1 Reaction@diverjer If you have internal bleeding from the hernia operation and it is not drained you could lose the cremaster muscle if that gets engorged with blood.
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3 Reactions@jim18
Made note to ask doctor, thanks.
@jeffmarc
I keep thinking I should post pis, I could keep the XXX rated part out.
Question about catheter leakage, wonder if anyone ever heard of. I know this is gross. Had this catheter in now 10 full days and there has been some leakage around tube that goes in penis. This only started last couple days. But the leakage had been minor and I just fold up a couple pieces of toilet paper and it doesn’t get very wet, just small spot, I thought no big deal. Then today I got some more leakage where I could actually see urine running out, small little stream. But it only happen when sitting on stool and penis is down lower than normal. Doesn’t happen when everything pulled up with shorts on. Showed wife tonight sit on toilet seat and nothing happen, she thought I was crazy and I thought I guess it stopped. But then all of a sudden a little stream came out around the tube from penis. I guess it was time for some draining and it took path of lease resident? Wasn’t straining or pushing. No kinks in drain or anything . Anyway, pull up shorts and then got everything higher and no little streams. Didn’t start until today. The only difference is tube more of uphill when it’s hanging down and only small uphill when pulled up with shorts. But still that didn’t matter until today and a little yesterday. I sure seem to be having a difficult, but then I don’t know anyone who went through this. Maybe this normal?