MRI Prostate Rating One to Five
Went through proton radiation therapy in 2010 (PSA: 6.47; Fleason 3+3; T1a) as slow-growing prostate cancer concentrated in a "lump" on the right node of the prostate. Radiation at Loma Linda Hospital.
PSA is now rising, now at 4.27; MRI mid-July 2024. The rating was five (5) with potential a recurrence of prostate cancer cells. Ratings of 1 through 3 mean no real issue; with ratings of 4 through 5 the possibility is likely. The pathologist "reads" the cell structure to determine to "subjectivity" of the rating. Meaning, it is an opinion.
Question: Has anyone had a similar occurrence? Or, a rating of 4 or 5 whereupon a biopsy showed cancer or not? My original diagnosis with a scan at Loma Linda indicated concentrations of calcifications within the prostate.
Anyone out there have similar circumstances? RH/Leesburg, Fl
Interested in more discussions like this? Go to the Prostate Cancer Support Group.
Congrats on going 14 years without recurrence!
I’m assuming that you mean, the PI-RADS score. When my cancer returned last year, my score was 5 and things were more serious.
You are fortunate in that Mayo has a campus in Florida. Based on my limited knowledge, you received your proton treatment and arguably the best most experienced place in the USA. It wasn’t an option for me to get my treatment at Mayo but I believe that their care sets a standard that most other medical systems are judged by.
My assumption is that a MRI guided biopsy, a PET-PSMA scan, and possibly even genomic testing on the pathology may be helpful in determining a plan of action for you.
Here is a link to Mayo’s website for their Florida location. https://www.mayoclinic.org/patient-visitor-guide/florida
Good luck on your continued journey!
Thanks..when my PSA began to rise, I contacted Mayo in Jacksonville and established a file with former records and patient numbers.
In the interim, I have contacted the physician who reviewed by initial case in 2010 at Loma Linda for an opinion.
The thrust of my general inquiry was "variances" in subjectively indicating PI-RADS score of 1 to 5. From my general investigation, the calcification which was noted originally 15 years ago can "jump" the PSA over time as it increases in size and density. It seems every guy's situation is different-not many which are identical.
I wanted to also alert others who maybe in or close to a similiar situation. Knowledge is power! Cheers/RH
My MRI report is below. Not sure if I should do another PSA test soon or wait 6 months for another MRI. Any thoughts appreciated.
HISTORY: Prostate specific antigen above reference range R97.20: Elevated prostate specific antigen (PSA)
COMPARISON: None.
TECHNIQUE: Multiplanar multisequence MR imaging of the pelvis performed without and with intravenous contrast using the prostate protocol. Multiple B-value diffusion-weighted imaging in the axial plane was also performed through the prostate gland with
ADC mapping.
IV Gadavist 10 mL.
FINDINGS:
PROSTATE VOLUME: 6.8 x 4.29 x 6.1 cm with a prostate volume 95 mL.
PERIPHERAL ZONE: Diffuse abnormality of the peripheral zone noted characterized by low T2-weighted signal and mildly elevated diffusion-weighted signal and mildly decreased ADC signal without focal lesions. The capsule is well defined.
TRANSITION/CENTRAL ZONE: Diffuse nodular transition zone noted
OTHER PELVIS: No pelvic adenopathy identified. The seminal vesicles appear symmetric. The bladder appears normal.
Impression
IMPRESSION:
Diffuse abnormality the peripheral zone. This is a nonspecific finding and can be seen in both acute and chronic prostatitis or other inflammatory process and rarely in diffuse malignancy. Malignancy being considered less likely in the presence of
a well-defined capsule. Consider follow-up MRI in 6 months.
FINAL PI-RADS: 3, intermediate. The presence of clinically significant cancer is equivocal.
@ezupcic, what did you and your doctor decide to do?
Hi. The radiologist recommended another MRI in 6 mos which based on his narrative seems reasonable. My urologist agreed to another PSA in 3 months but if my numbers increase then probably a biopsy. In the meantime I’m hoping to get a PSE to see what it says. Hope I’m taking the right approach. Thanks for asking.