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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 - what I do with those pads is pull off about an inch of the paper from the top and bottom, so it exposes just enough of the sticky tape to hold it in place without pulling out all the lining.
It’s actually one of the reasons why I prefer the no-name pull-ups over the Depends - the generics are a lot more durable that way.
@diverjer The follow up with neuro is very important to monitor your progress brain-wise…but he will not be the one to keep you healthy going forward; you should make a cardiac appointment immediately.
@turtbean is a prime example how a little AFib can occur after surgery and this is what you possibly had; they probably did an EKG for this already but it can happen again.
The cardiologist can put you on a 24 hr monitor (a little patch that they paste on your chest) to see if you’re firing on all cylinders correctly.
You don’t want to stay on blood thinners unless you absolutely have to. Best,
Phil
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2 Reactions@heavyphil
I also did make what they call an ER followup appointment request with a heart doctor.
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2 ReactionsDoesn't seem the followup recommended by ER are much of a concern. Neurologist soonest is May 26th and and if that didn't work next available was in July. Heart doctor APRN (not real doctor) soonest is June 30th.
No wonder ER is packed every day. This is in Topeka Kansas big capital city of Kansas. Our daughter said there just are not enough doctors here and they are losing more. Some moving to Kansas City, and some retiring.
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1 ReactionGuess they took pity on me and moved heart doctor up to May 28. I was nice, just told them I didn't like the June 30th date, but did it in a nice way. Wow, 4 doc appt next week, urologist, neurologist, oncologist and heart doc.
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2 ReactionsHad my follow-up with neurologist this morning and he said that he's pretty sure I had a TIA because of speech issues I was having. Said all the tests have been run except he wanted another test some kind of echo of the heart, but not the standard old echocardiogram, nurse said it was more involved. They haven't got it scheduled yet.
Then when I got home I got a call from the urologist surgeon's APRN. She said you have an appointment at 4:20 this afternoon, I said I know. She said I understand you have questions can't we just answer them over the phone, I said no I have lots of questions about the pathology report and about incontinence issues and not being able to pee when I know my bladder is full. She tried to get me to talk over the phone instead of coming in at 4:20 p.m.. I said I want a face to face and talk to surgeon , then she said well can you come in early I said well what about 4:00 she said that would work. I got to tell you that call from the surgeons office really pissed me off. He hasn't seen me in person since the April 30th prostatectomy and the May 1st emergency surgery to stop atrial bleeding. Now I'm beginning to wonder if I made the right decision and also wonder if it wasn't his screw up that caused the atrial bleeding that I lost so much blood from and had to have emergency 2am surgery? I still feel weak lightheaded.
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3 Reactions@diverjer It sounds like you are justified in not trusting or having confidence in that surgeon. He doesn't seem concerned enough about your welfare. Can you quietly look for a consult with someone else, or somehow ease him off your case?
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4 ReactionsIt wouldn't be easy as I doubt another surgeon would want to take over this early after surgery. Also, only a few others available in town. Going to have serious talk and let him know that it appears to me he is not taking me serious.
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2 ReactionsWell last week was a full week of visits to doctors, mostly because they say I had a TIA a few days after the two surgeries in less than 10 hours. Took the prostate out and then decided to repair inguinal hernia (4 hours) first surgery. Then at 2am cut me open again to stop a bleeding artery. I think all that is why I had a TIA if I really did have a TIA? ER visit showed MRI and CT of brain fine, but still wanted me to follow up with neurologist, urologist surgeon, heart doctor and I already had appointment with oncologist already planned. All in same week!
Neurologist said because of trouble talking, I most likely did have a TIA. He wants me to have a Transthoracic echocardiogram (which they still haven’t scheduled been almost a week). Then If transthoracic echocardiogram is without significant abnormality, consider TEE, loop recorder for possible subclinical atrial fibrillation. That loop recorder is a small thing they stick in you for 3 years. It’s a tiny thing they showed me, that sits under skin and calls into the office. Told doctor I didn’t want that. They said think about it.
Next went to urology surgeon who pretty much said nothing, said pathology not too bad and we would do a PSA test in couple months. No he wouldn’t send me to Pelvic PT until I healed up more maybe 3 months. Not to worry about all my leakage, it’s still early. He is the one that tried to make my visit with a phone call, but I insisted on office visit. Think surgeon just wants to cut on you, he is not known for being a great people person, but supposed to be good at surgery.
Next went to oncologist, he was really great! Young guy just not long out of med school at KUMC, but working here in Topeka. He wants uPSA in 2 weeks which is 6 weeks from removal of prostate. Much sooner that surgeon, which I think is good idea. Said PSA should be undetectable (less than 0.1 ng/mL). Would then watch my PSA every 3 months. If it does not decrease to undetectable or it recurs (past 0.1 ng/mL per NCCN, 0.2 per AUA), would consider salvage radiation given his multiple high risk features. Also, doing Anemia work up plus lots of other blood test as I lost so much during multiple surgeries. This guy really listen and seems to be great.
Then my last doctor visit of the week was heart doctor as the ER people told me to go to. Right away, he wanted to do the TEE, loop recorder for 3 years. It must be some standard if they think you had a TIA. Told him I really didn’t want it. Then he reviewed the reasoning for the transesophageal echo recommended by Neurologist. Since I didn’t want the TEE Loop recorder, he said he wanted me to do at least 30-day mobile telemetry. Some kind of holter monitor that actually sends live data back to the office. I said okay, it will arrive in a couple weeks and I am suppose to put it on myself. I had a 5 day one a couple months ago and all was normal, but they didn’t care. Want to see if I am having Afib or something like that.
Lots of test coming up, but no doctor visits next week. Well I may have to go in if they ever schedule the Transthoracic echocardiogram. Prostate removal is bad enough, didn’t need this TIA thing and it has to be because of those multiple surgeries with a 79 year old man. And there is no way to know if I really had one.
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2 Reactions@diverjer I think you should do some kind of monitor - what’s the big deal after all you’ve been through?
My friend had a stroke (possibly from A fib) and he’s still in a wheelchair, has a feeding tube and wants to die…
Phil
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