@greg52
I’m 67 years old, had a PSA of 7.8 and my early October mpMRI showed three PI RADS lesions…one 3, one 4 and one 5. So, my situation is similar to yours…except my age.

I too was quite concerned, especially because of what I had read about PI RADS 5 lesions, immediately after I received my mpMRI report.

A few weeks after the mpMRI, my urologist performed a Fusion biopsy of 15 areas (9 cores in the three mpMRI lesions and a standard “random” 12 core sampling).

The “4” and “5” mpMRI lesions came back with Gleason 3+3=6 cores (in only 5-10% of specimen) and the “3” lesion came back benign!

However, 2 of the cores taken in the 12 core “random” sampling came back with Gleason 3+4=7 cores (with 10-20% of pattern 4 cancer).

The lesson here is not to get too concerned about an initial PIRADS 5 lesion AND make sure your urologist also does the standard “random” 12 core sampling protocol, besides sampling the “targeted” MRI location(s), when going for your initial biopsy.

Next week I will review a 2nd opinion on the biopsy pathology and a Decipher Score of the biopsy cores; neither of which I’ve seen - yet - and it’s been 2 months since I made those requests.

I am also waiting to get my first, post biopsy, PSA test (one must wait 3 months for the prostate to heal after a biopsy, before getting another PSA level check).

The main thing I have been doing through all this “wait time” is taking action regarding the things I can control and change.

No matter the outcome of your MRI results and any subsequent options you may (or may not) need to consider…there is one thing that you can definitely do…carefully examine your current diet and exercise routines and read (and take action) regarding that which is known to be best for good prostate health.

During the last 3 months, since receiving my mpMRI results, I’ve implemented a significantly modified diet (primarily whole plant based) and doubled my aerobic exercise routine.

I’ve lost 20 lbs and dramatically improved my overall health (no longer need a CPAP machine, no longer have shoulder inflammation, lowest cholesterol levels in 38 years and my average resting heart rate dropped 10% to 53 bpm).

Obviously, I have no evidence (yet) that this is helping to reduce my PSA; but I will soon find out.

Every man responds differently with news like that which you have just received and my actions may not be appropriate in your situation, for a variety of reasons.

Even so, it seems to me that all of us who have been forced to embark on this unknown journey would benefit from taking action over that which we have the most control.

All the best to you and may God bless you while you wait and give you the courage to change the things you are able to change.