MRI PI RADA 5 tz/afms lesion: What are the chances it's cancer?
New to the group. 57 years old. Last regular blood work revealed a PSA of 5.91. There has been a steady increase since 2019 when my first PSA was a 1.8; followed a 2.1, a 3.57 and then the 5.91. Referred to my uro for a consult. 3t mri on 3/16 revealed a PI RADS 5 , 19mm x 10 mm lesion in the anterior transition zone extending into the fibromuscular stroma. Multiple areas in peripheral zone that are PIRADS 2. PSA density is .15. Have some moderate bph but nothing the uro thought was overly concerning. Did another PSA test at the consult for the biopsy less than 4 months from my 5.91 result and that revealed my current PSA is now at 6.7. Targeted and random core fusion guided biopsy set for 4/18. Anyone have knowledge or experience with tz/afms lesions, chances of cancer with the PI RADA 5, and if so, treatment options? Difficulty finding much info on the internet for transition zone cancers.
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I've been going through a similar journey as you my friend. PSA 5.3. Two suspicious lesions found on MRI (PI-RADS 5 and 4). Had an MRI guided fusion biopsy two weeks ago. Got results last week and have Gleason 7 (4+3) intermediate prostate cancer. PI-RADS 5 have around 80% chance of being prostate cancer. The only way to diagnose it and determine a treatment plan is to get pathology report from biopsy. I would highly recommend that you check out Prostate Cancer Research Institute on YouTube. Dr. Mark Scholz, a medical oncologist, presents short videos on just about anything you can think of related to prostate cancer. I hope this helps you.
Thanks for the info. Was yours in the peripheral zone or transition zone?
Both in peripheral zone. One on each side.
I had a PSA of 5.45 and had an MRI which showed 2.5cm lession in peripheral zone on right side and a PIRADS 5. The biopsy was Gleason 7 (3 4) . I am 69 and had an RP in September 2022. The surgery biopsy shows stage 3a cancer but nothing seen in the lymph nodes. The 6 month PSA shows no signs of cancer.
Sounds great. Wishing you continued good results.
jdy697: my psa was 10.2 with 3+4 Gleason no peripheral but my brother had peripheral with a 6.5 psa. He used a center of excellence in New York City. I used Orlando Health cancer center and we both used the Mridian viewray radiation machine.
Here is a list of research areas that I went through to get some answers. Since your biopsy is coming up, a Decipher test may help you and your Dr's decide treatment.
Nccn.org: Many doctors follow their guidelines, and it is there for doctors and patients
Decipherbio.com: Takes a slice of the biopsy which helps evaluate aggressiveness and modes of treatments
Viewray.com: MRI/Radiation machine combination unit
Mevian.com: Proton therapy radiation machine
Globalroboticsinsititute.com: A doctor I looked into with 18,000 robotic surgeries when I was considering prostate removal in Celebration Fl.
PCRI.org: The Prostate Cancer Research Institute helps men and caregivers research their prostate cancer treatment options. Lots of videos.
Thanks for the excellent info!
I had my fusion guided biopsy on 4/18 with no resulting complications thankfully. Got the phone call this morning that I have cancer. Results from the biopsy shows Gleason 7 (3+4) in each of the two targeted cores ( pi rads 5 lesion; Doc was able to get both ends). Next step is setting up an appt with my urologist to begin discussing treatment options. As a new member of this esteemed group of men I want to particularly advocate for mri’s prior to biopsy. Doc said if I hadn’t had the mri he wouldn’t have found the cancer as it was in the transition zone extending into the anterior fibromuscular stroma. A difficult location to biopsy because of its anterior location. If at all possible get the mri before biopsy! My cancer could have been a different story if it was found a couple years later.
Well I think they would have found mine without an MRI. Most of my test results were borderline PSA of 4.2 sent me to the Urologists and there were no indication with the DRE and then my PSA went down to 3. My Urologists insisted there was no way insurance would pay for a MRI as it is too expensive. I later discover that the Biopsy cost $10K and the MRI was $2.5K and insurance had no problem with it.
PI-RADS 5 means 95% chance of cancer. I had five lesions, PI-RADS 5, 4, 4, 3, 3. Lots of cancer (confirmed by biopsy) but all contained. They were all over the place, the #5 was in the anterior right transitional zone. PSA had climbed to 11 and a second MRI showed growth and pushing against the capsule. So I had an HDR brachytherapy a month ago.