PI-RADS 5 score on a prostate MRI: What does this mean?

It shows the likelihood of cancer being present.
It's on a scale of 1 - 5
5 is a very high likelihood of cancer.
Next step for you is a biopsy.

But it's not all bad.
Most of us have been through it & always happy to share our experiences, so you know roughly what to expect.

I had level 3 on the mri so they did a exodos biomarker test which ended up on the high side currently awaiting treatment, level 5 is a lesion 1.5cm or larger so your urologist will use a ultrasound along with your mri which will guide the biopsy best of luck.

It is very likely they are wanting to do a biopsy and try to get some samples from that PIRADS 5 lesion. there is a very high chance of it being cancer.

Rather than get a biopsy, you could get a PSE test and see if that says you need a biopsy Because it found cancer in your blood. It is however, very likely that it means prostate cancer.

In addition to the PIRADS 5 score, did the MRI report mention anything about extracapsular extension, seminal vesicle invasion, or perineural invasion?

PIRADS 5 indicates that “clinically significant cancer is highly likely to be present,” but it is not definitive of prostate cancer; only a biopsy can do that. (So for now, try to relax….)

As for what to expect next:
> As others mentioned, the next step is typically an MRI-guided biopsy (unless you want a second opinion on the MRI scan first).
> They may offer one of two methods of biopsies - transperineal or transrectal. (Transperineal is usually preferred, with general anesthesia.)

@ctsenior46

My first prostate mri said pirads 5. I had focal therapy and took the lesion out, though it took two focal therapy sessions. Just be aware most places push for over treatment. Even pirads is sometimes used to push people to the two big money treatments surgery and radiation because it is very subjective as my next mri after that said pirads 2. Just because you had pirads 5 doesn't mean you should jump to the big two money treatments in your thinking, just keep that in mind. Most discussions push the over treatment path, you don't have to follow that. Some people do like the idea of over treatment and maximal treatments, so up to you where you are on that.

@bjroc Agree that there is a lot of over treatment being done but not always for the money. Some doctors are more aggressive then others.

The MRI is just a piece of the puzzle. You should never treat and don't think a doctor would treat on just an MRI finding. This is why a biopsy is next procedure to do to see extent of cancer. If Biopsy shows significant cancer then a PSMA test should be done. Then you can look at options to treat. Of course it's always a plus to do some genome tests like the Decipher, Ateria AI, etc
Wishing you the best.

@copyman Well I had three biopsies, 6 mri, 2 psma, decipher and all of them there sure was a push to get maximal treatments every step I took. So while it isn't always money it sure looks like a hard hard push for sure. I have many physicians in the family, we have done roles at NIH, and in decades in academia. The push today is truly even physician academics have to meet what they call wRVU targets or risk being cut, so even academics have a real money push. I wish they didn't both for myself and my family members who are in this field (not in prostate for sure though).

I was a PIRADS 5 with extrascapular extension in Dec 2021. Next step for me was a biopsy that confirmed prostate cancer (Gleason 8). That was followed by surgery two months later (Gleason score increased to 9) and a biochemical recurrence six months after surgery requiring hormone therapy and radiotherapy. I am happy to report that given all that treatment for my aggressive cancer, my PSA has remained undetectable for three years. I am feeling very good at this time, doing all the things I used to do with the added bonus that sexual function has returned (it took awhile). There can be light at the end of the tunnel.

@edo

Fantastic! Can you please share your experience and any insight into your sexual health journey? Post surgery and post salvage experience would be beneficial. What helped the most ?

Thank you this is very comforting.