BIRADS 5 AND 155.0 cc prostate

Welcome to the club that no one wants to be in! You will find a lot of information on this forum by members with far more experience then me. Keep in mind that what you read on these online forums are mostly from people that are having bad side effects. Don't let that scare you as there are many more people that have no side effects and no need to post on these forums.

I think you meant PIRADS 5 from the MRI. This means the lesion is highly likely cancer. The Biopsy is the correct next step to grade the cancer. Then a PSMA PET/CT scan would be best to have and perhaps a decipher test. Sometimes a 2nd opinion on biopsy slides helps but not always necessary if you are being seen by a top cancer center. I would not jump to surgery. Many who have surgery end up needing radiation anyway and also have side effects. Take your time to look at all options and get 2nd & even 3rd opinions. There are so many options to choose from. PC is a slow moving cancer. Do your research.
Best of luck.

@copyman Thank you so much for your response and the info shared. Yes-PIRADS 5. The Biopsy is scheduled for next Friday. Do I need to request that the Decipher test be run on the biopsy tissue samples? Or is that done if prostate is removed? My urologist did state a PSMA PET would be scheduled as well. Thx again for taking the time to reply. Helluva learning curve right now!

@copyman also- I am told that the sheer size of my prostate makes radiation incredibly difficult. Ill certainly be getting a few opinions before taking any course of action.

A normal prostate is around 40 cc. Yours is definitely quite large at 155cc. Just today, a Mayo radiation oncologist was talking about the problems, radiating a large prostate. He said about 75 cc was the most he wants to work on, though they will work on larger ones. It’s a problem with radiation. You may need to have surgery..

The tissue from your biopsy could be used to get a decipher score. That would be a good idea unless they find a lot of aggressive issues which would negate the benefit.

Good to hear you’re having a PSMA Pet test. With that high a PSA it is definitely essential.

Until you get the biopsy results, you won’t know much but the PIRADS 5 Usually implies you have cancer, though it isn’t always true. The real question is how High is the Gleason score and is anything else found in the biopsy? The other things to be concerned about in the biopsy are if these things found intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

If you get a biopsy, try to make sure that you get a transperennial Biopsy. Less chance of infection than a transrectal Biopsy and they can actually get to more parts of the prostate with that biopsy.

Thank you so much for your reply and the insiggts you shared! Forgive my fat fingers! Prostate total volume is 155.0 cc not 700- yikes! Still huge. Prostate measures 5.7 (AP) x 6.3 (TV) x 8.3 (CC) cm. And so that complicates things as I understand it.

@floridaman take a deep breath and take notes- your biopsy and PETScan will reveal most everything..IF you do have prostate cancer, then dont despair..everyone here does ! but you will prob be challenged in a few ways by the treatment..but you can do it !

I hope you are negative but from your info, it sounds like you do have PC..but lets wait for all the facts..then you will be given some treatment options ( probably) dont be afraid to ask questions and there is a world of exp on this site that will be helpful I am sure.

For now relax and take everything one day at a time..

@floridaman
As you may have noticed, I changed what I wrote when you changed it from 700 to 155.

@xahnegrey40
Thank you so much for the warm welcome and moral support. Already got some great direction from the responses. Incredibly generous of all of you to share your experiences and insights! THANK YOU!

@floridaman Also, in certain cases where surgery is not indicated or not advisable due to medical reasons, the prostate can be reduced either by a TURP or laser HoLEP procedures thru the urethra.
Removed tissue can also be analyzed for Gleason score, etc…
You can then be a candidate for various forms of radiation if the prostate has been sufficiently reduced in size.
Phil

@floridaman I was in the same situation as you with the size and mri results. I had the decipher done on the biopsy which came back .34 low risk. My urologist recommended a simple robotic prostatectomy which remove 101 grams of prostate around my urethra so I would pee again. That worked Great ! He didn’t recommend a radical prostate removal because of it’s size would cause a lot of blood and diapers for ever I have one tumor in the prostate, no where else He recommended active surveillance. Year later this past Jan 2026, I had a PSMA. Came back negative! Also I forgot to mention my pathology report on the biopsy a year ago gave it a 4+3=7. Which is opposite of a decipher .34 !! I may ask for the slides to be read by John Hopkins. I hear that 1 out of 2 come back down graded from what the original pathologists reported. I’ve heard that due to liability, that many are upgraded from some pathologists teams Right now I am going to talk to my urologist about IGRT radiation. Heard that it can be cured! And I want to live longer than SS believes I will 😂. I listen to PCRI on YouTube Very good experts