Discouraging MRI Report

Not the MRI I was hoping for……and words of advice. I’ve gone from a pirads 2 with no lesions to this in one year. PSA currently 8.8. Feeling a little devastated after all my efforts seem to have failed.

Impression
IMPRESSION: 1. At least 4 regions of concern on a background of relatively diffuse signal abnormality of the peripheral gland of the prostate, with the highest PI-RADS category: 5. 2. No pelvic lymphadenopathy by size criteria. 3. Additional chronic findings as described. PI-RADS v2.1 is designed to predict the probability of a cancer which is deemed clinically significant as defined by: pathology/histology Gleason score greater than or equal to 7 (including 3+4 with prominent but not predominant Gleason 4 component), and/or volume greater than 0.5cc, and/or extraprostatic extension (EPE). PI-RADS v2.1 Assessment Categories: PI-RADS 1: Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2: Low (clinically significant cancer is unlikely to present) PI-RADS 3: Indeterminate (the presence of clinically significant cancer is equivocal) PI-RADS 4: High (clinically significant cancers likely to be present) PI-RADS 5: Very high (clinically significant is highly likely to be present) http://www.acr.org/Quality-Safety/Resources/PIRADS/ Dictated by: Will G Larison, M.D. on 9/22/2026 9:08 AM PDT Electronically signed by: Will G Larison, M.D. on 9/22/2026 9:33 AM PDT
Narrative
MRI PROSTATE W WO CONTRAST CLINICAL INFORMATION: Elevated PSA. COMPARISON: 10/6/2025 TECHNIQUE: Multiplanar multisequence 3T MR imaging of the pelvis performed without and with intravenous contrast utilizing the prostate protocol. Dynamic contrast enhanced series as well as multiple B-value diffusion-weighted series with ADC mapping were acquired. CONTRAST: 9 mL of intravenous Gadavist (Gadobutrol). FINDINGS: LIMITATIONS: None. PROSTATE Size: 4.1 x 6.2 x 6.3 cm. Volume: 83 mL based on ellipsoid calculation. Central Gland BPH Changes: Moderate with large median lobe. Pre-Contrast T1 Changes (Blood): Absent. LESIONS: Persistent signal abnormality throughout the bulk of the peripheral gland now with suspected regions of superimposed concern as described below. LESION # 1. Best seen on series 7 image # 23. Location: Peripheral zone within the mid gland at the 5 o'clock position. Size: 1.1 cm. T2 Characteristics & Score: The lesion demonstrates a T2 score of Peripheral Zone 4: Circumscribed, homogeneous moderately hypointense focus confined to prostate and less than 1.5 cm in greatest dimension. DWI Characteristics & Score: The lesion demonstrates a DWI score of 3: Focal hypointensity on ADC and/or focal hyperintensity on high b-value DWI. Dynamic contrast enhancement: (+ ): Focal, and earlier than enhancement of adjacent normal prostatic tissues, corresponding to suspicious finding on T2W/DWI. LESION PI-RADS CATEGORY: PI-RADS 4 - High (clinically significant cancer is likely to be present) LESION # 2. Best seen on series 7 image # 23. Location: Peripheral zone within the mid gland at the 7-8 o'clock position. Size: 1.4 cm. T2 Characteristics & Score: The lesion demonstrates a T2 score of Peripheral Zone 4: Circumscribed, homogeneous moderately hypointense focus confined to prostate and less than 1.5 cm in greatest dimension. DWI Characteristics & Score: The lesion demonstrates a DWI score of 4: Focal marked hypointensity on ADC and marked hyperintensity on high b-value DWI; measuring less than 1.5 cm in greatest dimension. Dynamic contrast enhancement: (+ ): Focal, and earlier than enhancement of adjacent normal prostatic tissues, corresponding to suspicious finding on T2W/DWI. LESION PI-RADS CATEGORY: PI-RADS 4 - High (clinically significant cancer is likely to be present) LESION # 3. Best seen on series 7 image # 16. Location: Peripheral zone within the base at the 7 o'clock position. Size: 2.1 cm. T2 Characteristics & Score: The lesion demonstrates a T2 score of Peripheral Zone 3: Heterogeneous signal intensity or non-circumscribed, rounded, moderate hypointensity; Includes others that do not qualify as 2, 4, or 5. DWI Characteristics & Score: The lesion demonstrates a DWI score of 5: Focal marked hypointensity on ADC and marked hyperintensity on high b-value DWI; measuring at least 1.5 cm in greatest dimension or demonstrating definite extraprostatic extension. Dynamic contrast enhancement: (+ ): Focal, and earlier than enhancement of adjacent normal prostatic tissues, corresponding to suspicious finding on T2W/DWI. LESION PI-RADS CATEGORY: PI-RADS 5 - Very High (clinically significant cancer is highly likely to be present) LESION # 4. Best seen on series 7 image # 22. Location: Peripheral zone within the apex at the 3 o'clock position. Size: 1.7 cm. T2 Characteristics & Score: The lesion demonstrates a T2 score of Peripheral Zone 3: Heterogeneous signal intensity or non-circumscribed, rounded, moderate hypointensity; Includes others that do not qualify as 2, 4, or 5. DWI Characteristics & Score: The lesion demonstrates a DWI score of 5: Focal marked hypointensity on ADC and marked hyperintensity on high b-value DWI; measuring at least 1.5 cm in greatest dimension or demonstrating definite extraprostatic extension. Dynamic contrast enhancement: (+ ): Focal, and earlier than enhancement of adjacent normal prostatic tissues, corresponding to suspicious finding on T2W/DWI. LESION PI-RADS CATEGORY: PI-RADS 5 - Very High (clinically significant cancer is highly likely to be present) Prostate margin: EPE: Threatened. Local invasion: No local invasion identified. Pelvic Lymph Nodes: No lymphadenopathy by size criteria. 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.