Connect
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.
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
Well got my 6 week PSA test back, they didn't do a uPSA, just normal old PSA. However it was lower that what the oncologist said he wanted to see in, he said wanted less than 0.1 ng/mL It came back with a level of .06 ng/ml. So I guess that is okay and what doctor wanted to see. Still surprised they didn't do a uPSA? Maybe later after more time passes?
Looked at the operating notes from surgery, there are a lot of them from both surgeries. Wonder do they record when they are operation or make up all these notes after surgery from memory, sure are lots of detail. One statement here I am going to ask about, wonder if it's a typo. I wonder about the statement "early return of incontinence" Sounds like he did something for early return of incontinence????? Who would want that?
From notes:
Both lymph node packages were placed in the Endo Catch bag and then I did a V-Loc stitch that I sewed from the posterior layers of Denonvilliers up to the rectourethralis, bringing the tension off the anastomosis and also provide a backboard of support and early return of incontinence, and I did a urethral anastomosis with a 2-0 vlock tied together with a pledget and peeled the vas in between.
@diverjer ask the Doctor Who wrote the note
-
Like -
Helpful -
Hug
1 Reaction@diverjer That’s a great post op PSA. Don’t get hung up on uPSA…what’s the difference from .058? Clinically - which translates to ‘realistically’ - these small differences don’t really matter in the long term.
Others may disagree, but we have a limited # of treatments available for recurrence and they are pretty well standardized (with a few tweaks).
Phil
-
Like -
Helpful -
Hug
2 Reactions@kenpelan
I plan on asking Tuesday, Google says:
Your query outlines the goals of surgical tissue reinforcement and tension reduction, often seen in reconstructive urological or colorectal procedures. Bringing the tension off an anastomosis (surgical join) and providing a backboard of support are techniques primarily used to promote healthy healing, prevent leaks, and allow for the early return of continence
There was several pages of notes, going to ask if he does those after surgery or talks into a recorder during surgery. That would be a lot to remember to put in notes.
@diverjer
A normal old PSA would’ve said <.1. The fact that you got .06 Means that you did get an ultrasensitive PSA. I’ve never had anything Lower than <.1 Since I get the old standard PSA test.
This is a really good result. They want you to be undetectable after prostate cancer surgery and you are there.
There are surgery techniques that can give you a chance of having no incontinence. It could be that is how they did your surgery.
That explanation of the surgery is definitely going to require expert advice to understand it. AI may be the expert you need.
-
Like -
Helpful -
Hug
3 ReactionsGoogle inquiry seems to give a decent answer, thinking his notes should read "early return of continence" instead of "early return of incontinence". will ask him on Tuesday.
I can tell you I am not having any early return of continence, it is just miserable trying to go shopping, do any yard work, even going out to eat or playing games with friends. But I do all these anyway as I don't want to make my wife's life anymore stressful. After 43 years of marriage I don't want to stress her out by being so negative, even though I really feel negative.
@diverjer Notes were probably created by AI from a recording. If anyone proofed, it was probably his staff.
Well got that loop recorder put in today. That place was really busy, took about 2 minutes for doctor to put it in. And he was really busy, going from room to room, I could hear him talking. They were putting in a lot of those things and he said mine was a new 5 year one. I told him I really didn't want it at all, but was badgered into it by my family. They said if I get tired of it, I could have it taken out. I think that recorder is an easy thing to do and makes them lots of money. However it was easy and painless, they nurses were nice. They know my daughter who is also a nurse at same hospital.
Urologist visit went okay that one line was suppose to say return of continence- not return of incontinence. He said transcribing error. He still won't refer me to pelvic until 3 months after surgery. I guess he is stuck in some old ways as I don't think that is current thinking.
Doesn't make any sense why he won't go for it, he did say I could go back to weight lifting. He actually goes to same gym I go to, I see him every now and then. Oh yea, then the loop recorder people told me not to lift weights for 10 days. I miss weight lifting, but still walk 2-3 miles a day.
-
Like -
Helpful -
Hug
1 Reaction