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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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@heavyphil It’s the 6th or 7th blog post down.
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1 Reaction@heavyphil
I agree something to ask about as things get ruled out. Even though everything appears normal, I agree I don’t think lymphedema can be ruled out. I don’t think ultrasound is a definitive test that a radiologist sees lymphedema. I think their are more tests to determine if that is the cause, which I believe cannot be ruled out .
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2 Reactions@heavyphil
Thanks, lot of good info in that article. Not sure what other test they would do, guess they could do another CT scan. Seems I been getting several CT scans, not sure if all that radiation is good. I know they still plan on doing a CT scan on that 5th rib that showed up way back on 2/27/26 PSMA-PET/CT. They all say 100% sure it's nothing but old injury. However, said they would order a CT of the rib, will bring it up in my appt with oncologist later this month. No swelling except one spot right side groin, same side of the hernia. Almost feels like that inguinal ligament is what is sore and the swelling is over top of it? Seen a picture of inguinal ligament while checking things out, prior to that didn't know there was such a thing.
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1 ReactionThis information is from google AI. I guess one could keep pushing for an answer to know why, but then is there anything that could be done. At least medically you would know the answer and it is something now additional that you have to put up with. This paragraph about clinical history seems to answer it to me and it seems like it is lymphedema.
How Specialists Actually Prove It's Lymphedema When an ultrasound comes back "normal" but the swelling persists, doctors rely on other methods to confirm lymphedema:
Clinical History and Symptoms: If you have had pelvic surgery, radiation, or a severe infection, a specialist will often diagnose lymphedema based on your history alone.
Lymphoscintigraphy: This is the gold standard diagnostic test. A tiny amount of safe, radioactive dye is injected into the skin, and a special camera tracks the fluid's live movement. If the dye gets stuck or moves backward in the groin, it proves the lymphatic system is failing.
Indocyanine Green (ICG) Lymphography: A specialist injects a fluorescent dye and uses a near-infrared camera to watch the fluid move through your skin vessels in real-time.If you are facing unexplained groin swelling.
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2 ReactionsI am going to keep on them the best I can, hard to get in to see anyone except PA or APRN. Urologist seems to not care, but could try him again? He just said normal healing! Have appt with oncologist and a RO later this month, they might have ideas? Also, with the PA that ordered this sonographic is easy to deal with the 2 days a week she works. Then al
Statement that Incidental small morphologically normal small lymph node is present does sound good and some searches say that prostatectomy and inguinal hernia repair 3 months ago commonly cause local, benign, reactive changes as the body heals.
Still, I would like more answers as to why this is happening. Since it is on same side as hernia, I hope it just a healing process. I have been doing weight lifting, but urologist said that is okay. I also see the urologist later this month and have my introduction appt with pelvic therapist who might know something. .
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1 Reaction@diverjer
You can just get specific and say you googled it and it says specifically if you are facing unexplained groin swelling and the ultrasound is normal ask them specifically or show them googles response about the two diagnostic tests for groin lymphedema including the “gold standard one” and ask them about what they think.
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2 Reactions@diverjer And speaking of your hernia, I had dinner with a friend last night who had to have her gallbladder removed. As they were wheeling her into the OR, the surgeon told her that her scan also showed a hernia, and he would let her know what he decided to do about it.
When she woke up from anesthesia, he said that he actually used the hernia as his port of entry for the camera, since it avoided him having to cut in a different spot and cause more damage.
After he was done with the gallbladder removal, he repaired the hernia with mesh. This was about two months ago and she feels just fine.
But again, her surgery was not as complicated as yours.
Phil
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2 ReactionsI am wondering if my hernia repair really worked? Still got that swollen area over where they did repair and it is sore, not bad just a little sore. Did the old cough test and believe I feel just a tiny bit of something pushing when cough. Nothing felt on other side. But it isn't much that I feel and have to move finger a bit toward center and not straight up. STILL wish they hadn't done the hernia and just did the prostate like I asked!!! Hernia hadn't been a problem for 40+ years. Anyway, my PA did order a CT scan, but it's not yet scheduled- that can take awhile to get scheduled. Then the oncologist scheduled a CT of 5th rib posterior (a spot that lite up on PSMA last Jan which they said 100% sure is nothing but going to check anyway). That seems like a lot of scanning, I will start glowing in dark. Think MRI would be better, but they can take months to get done.
Got this article sent to me that may be interesting? Little over my head!
PARP Inhibitors for Prostate Cancer: 5 Things to Know https://www.medscape.com/viewarticle/parp-inhibitors-prostate-cancer-5-things-know-2026a1000ocr
@diverjer
PARP inhibitors really work for people with genetic problems like a BRCA1 and BRCA2. They can be minimally effective with some other genetic problems like ATM, but for the average person with prostate cancer they are of no help at all.
There is one exception, If you get a somatic genetic test and it shows that your metastasis has one of the genetic problems, then it can help. Very low chance of this happening, but it does happen.
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1 ReactionThanks for the update, I get a lot of medical articles from Medscape. Usually 4 or 6 a day and understand very little of it, but do get some that sinks in my pea brain. Actually, I have taken a few of their 5 to 10 question test and actually passed!