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Sorry to hear of your news!
In active-surveillance terms, what you have described would generally be considered radiologic progression, BUT it is not yet proof of biologic cancer progression until a targeted biopsy shows a higher grade, greater volume, or extension.
Inflammation can imitate cancer on an MRI….this is what likely happened in my case….but my situation was the reverse of your recent MRI experience.
In my case the initial 3, 4 and 5 PIRADS lesions were no longer visible after 28 months and my PSA had dropped.
In your latest scan, four focal lesions, two scored PI-RADS 5 and showing early enhancement, are not something that should simply be attributed to inflammation without tissue confirmation.
Unfortunately, you can’t know what’s really going on without a biopsy.
You mentioned “Feeling a little devastated after all my efforts seem to have failed.”
What efforts have you been doing since your last mpMRI?
Was that mpMRi followed by a biopsy?
If so, what was your Gleason score?
Did you get a Decipher score at that time? If so, what did it reveal?
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@handera my October 2025 MRI was a Pirads 2 with no focal lesions so at the time I did not pursue a Biopsy just continued with regular PSA tests. It just seems like Urologists are reticent to order non standard of care tests like PSE or MPS 2.0 so I’ve done none of those. My PSA has fluctuated between 4.5 and now 8.8. My changed diet, HITT work ( more recently cycling rather than running), supplements from the evidence zone like MyPhyto and MyGutPlus, weight loss, etc have caused me to feel great but seem to have had no impact on prostate health. My dad had this at my age and had surgery so maybe that’s where I’m headed or SBRT depending on what the biopsy will show. Hopefully it will be transperineal if I can get one in a reasonable time frame. But you were the first person who I reached out to when this started for me and I appreciate your approach in dealing with this and all the research and wisdom you have shared.