Reading medical reports often involves separating the wheat from the chafe. As a layman, much of that you can throw out - most of it being descriptive - and just focus on the parts that add value to your next decision.

> previous MRI: PIRADS 2;

> PSA currently 8.8.

(With your initial MRI, did you get a 2nd opinion? One of the (many) truisms I’ve found since being diagnosed with prostate cancer (in 2012) is that a PIRADS score is a specialist’s educated and experienced opinion of what he (she) believes he sees in a scan image. However, much of the interpretation of images (as well as tissue slides) is often as much an art as it is a science, and depends on the skill and experience of the person interpreting them. What one sees as a PIRADS 2, another might see as a PIRADS 3 - and that might change your decisions. This is why it’s so important to get a 2nd opinion of results.)

> are you getting a 2nd opinion of these latest MRI results?

Current MRI results —>
LESION # 1. PI-RADS 4 - High (clinically significant cancer is likely to be present)

LESION # 2. PI-RADS 4 - High (clinically significant cancer is likely to be present)

LESION # 3. PI-RADS 5 - Very High (clinically significant cancer is highly likely to be present)

LESION # 4. Demonstrating definite extraprostatic extension; PI-RADS 5 - Very High (clinically significant cancer is highly likely to be present)

(None of those are definitive of prostate cancer; they do however, indicate a high probability of prostate cancer; only a biopsy is definitive.)

Prostate margin: EPE: Threatened.

Local invasion: No local invasion identified.

Pelvic Lymph Nodes: No lymphadenopathy

Bowel: Colonic diverticulosis.

The imaged small bowel and colon is otherwise normal.

Bladder: Thickening and trabeculation of the urinary bladder, often seen in the setting of chronic bladder outlet obstruction physiology.

Left ureterocele again demonstrated.

Abdominal Wall & Pelvic Girdle soft tissues: Bilateral fat-containing inguinal hernias.

Bones: No acute or suspicious lesion.

Other: No ascites (meaning no abnormal collection of fluid inside your abdominal cavity).
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The next typical step is to get a biopsy.