Three PSA tests in two months. 6, 7, 5.4. MRI indicates 1cm lesion.

What were your prior PSA’s prior to these three. Were they basically lower and stable before the fluctuations began. The lesion the MRI identified would have been rated using the PIRADS rating system, i.e. PIRADS 2 or a PIRADS 4. This identifies the likelihood of finding a clinically significant cancer or not and certainly leads to DR recommendations that might be why they are recommending biopsy.

Thanks.
Prior PSA
2
2.4
PIRAD (4)
Both opinions

OUTSIDE MR ABDOMEN AND OR PELVIS
Outside film interpretation requested by the urology service. Outside MRI of the prostate performed without and with intravenous contrast on 6/14/2026 was submitted for interpretation on 07/16/202-60
COMPARISON: No prior MR prostate for comparison
FINDINGS:
PROSTATE:
Volume: 53 cc
Exam quality: Moderate.
Peripheral zone: In addition to focal lesion below, there are band-like areas of T2 hypointense without associated significant associated restricted diffusion compatible with sequela of prostatitis/fibrosis.
Transition zone: There are a few encapsulated and/or circumscribed BPH nodules as well as T2 hypointensity between nodules
Lesion #1
Size: 1.0 cm
Zone: Peripheral zone
Location: Right posterior lateral at mid gland/apex, (350/16)
T2WI: Diffuse mild hypointensity, usually indistinct margin (T2WI score 2)
DWI: Marked diffusion restriction. (ADC: 859, Focal markedly hypointense on ADC and markedly hyperintense on high b-value DWI; <1.5cm in greatest dimension) (DWI score 4),
DCE: Positive.
Overall category: PIRADS 4- High (clinically significant cancer is likely to be present).
LOCAL STAGING:
Capsule: Intact.
Neurovascular bundle invasion: Absent
Seminal vesicles invasion: Absent
Other organ invasion: Absent
LYMPH NODES: Negative for suspicious lymph node(s).
BONES: Negative for suspicious bone lesion(s).
IMPRESSION:
PIRADS 4- High (clinically significant cancer is likely to be present)
1. There is a right PIRADS 4 lesion as described.

@charliebrowntri7
Definitely a mri fushion guided biopsy to get some bites of the PIRADS4. They will also do random grid to check the rest of the prostate. My PIRADS4 that led to my biopsy turned out to be benign, but the other core random grid samples found my cancer. Good luck and keep us posted regarding the biopsy

Thank you. I’m blessed to be with Mayo Scottsdale.

Yep...time for biopsy. Best wishes.

A PSE blood test will confirm, with 94% accuracy, whether you are likely,or unlikely to have prostate cancer. It is a 5 bio marker test from Oxford Biodynamics.

If you get a biopsy, you may want to be put out for it and it might help if you can get an mri guided fusion biopsy. Also, ask for a decipher test from your biopsy material as doctors do use the results to adjust your treatment choices.

FYI: Prostate cancer usually does not cause symptoms until it is Stage 4 metastatic. If it spreads to the bones it is quite painful. Fusion biopsy and Decipher results will guide future treatment or active surveillance depending on the results. Wish you the best.

Almost identical to mine. Biopsy showed Gleeson 8 and 9 8 out of 14 samples. Press ahead.

My PSA was within normal range and showed no fluctuations, but due to lower back/hip MRI, a lesion was discovered on the prostate. Later prostate MRI showed one PIRADs 4 lesion. Moved forward with a biopsy. The core of the fusion guided biopsy into the lesion was benign. However, one core in diff area returned a 3+3, GG1. Some prostatitis can mimic cancer on MRI imaging so not all PIRADs 4/5 is cancer. That said, the recommendation from COE was EXODS test first and then perhgaps biopsy and urologist was straight to biopsy to find out whats going on. Now, post biopsy on AS. Best wishes to you.