@handera I’m also wondering if lesions were missed on my prior two MRI’s or if these 4 are new over the last year.

@ezupcic
If your father or brother has prostate cancer it more than doubles your chance of getting it. Definitely sounds like you are in need of a biopsy before anything.

@ezupcic
I noticed your prostate density is only 0.106 (8.8 PSA / 83 ml). My prostate density was originally 0.179 (7.8 PSA / 43.6ml). So that is definitely in your favor...0.15 - 0.20 is usually where some concern regarding aggressiveness can occur.

I've attached my 3 mpMRI reports.

My original MRI (10/23) indicated the following about the largest (PIRADS 5) left posterior peripheral zone lesion: "There is indistinctness of the prostatic capsule in this region, for example seen on series 4 image 19 that is suspicious for mild local extraprostatic extension."
Two other right posterior peripheral zone lesions were also found, one with "early enhancement" and one without "early enhancement"....so I also had suspected EPE.

The second mpMRI (10/24) indicated that "Mild focal extra prostatic extension not excluded." in the largest (now somewhat smaller) left posterior peripheral zone lesion. The other two lesions could not be found: "Previously described additional lesions in the right peripheral zone are not well visualized today."

The third mpMRI (02/26) mentioned nothing about ANY peripheral zone lesions, simply indicating "Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis"...this is why my urologist suggested the three original lesion were likely just inflammation all along..... A new (much smaller) PIRADS 4 lesion was found in the "left; apex; anterior central gland", with some early enhancement, but no "No evidence of extraprostatic extension" and my PSA density had dropped to 0.145.

When I received that first mpMRI report, I also was quite concerned, mostly because I knew little about what it may or may not have meant. As mentioned, I had a TRUS biopsy two weeks later and received my Decipher information a month after that. That information, plus my research, put a whole new spin on my condition and I started a rigorous AS program.

It's been almost 3 years since that first mpMRI and the initiation of my modified ERASE program. The attachments show my level of aerobic effort over the last three years. This morning's run results are also included. My current routine is to run a Zone 2 10K on Monday, and a Zone 2 5K with two 0.25 mile HIIT runs on Wednesday and Friday...a total of about 10.5 miles per week.

Once you get your biopsy results (and Decipher score, if necessary) you will have much more information with which to assess your overall situation.

If my PCa is ever proven to progress, I probably will go with either MRI guided SBRT or proton therapy.

Meanwhile, I'll keep up with my modified ERASE protocol. IMHO even if you choose active treatment, one can't go wrong by implementing a rigorous aerobic/strength exercise program that is sustainable for you.

All the best going forward!