MRI Results: What are the chances the lesion is cancer?

You have not told us how old you and recent PSA results and 4k scores Unfortunately if you are in your sixties it is likely cancer.
All my tests came back borderline and my doctor wanted to go strait to biopsy which cost $12k. I got a 3 tesla MRI for $750 and it confirmed there were tumors.
They started me on Lupron and it was worse than the cancer. I had no energy could not walk, mentally confused, some days in the morning I could not get out of bed without holding on to the furniture. Do a net search Lupron ruined my life.
I had 20 proton beam treatments and it took me over 2 years to get back to normal. Why even do a biopsy without 4K scores it is just a more advanced blood test. Now they can do 5 session MRI guided proton treatments. There is also some new ultrasound treatment method.

I am not a doctor but found that mine had no idea what she was talking about. I think you will be fine good luck.

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It's not possible to provide a probability of prostate cancer, as each patient will be unique. But a follow-on biopsy is really the way to either eliminate or confirm it.

I had an ultrasound guided biopsy over a year and a half ago (age 67) at my urologist's office with a rising PSA. At that time there was no cancer found from 12 cores. When my PSA continued to slowly rise (trend line up), my urologist recommended an MRI (age 68). From the imaging results there were suspect areas seen and the recommendation was an MRI guided biopsy under a general. Funny thing, the MRI suspect areas gave no cancerous cores from the biopsy, but they did find a few cores in other areas they took samples from. My urologist said they had to look hard to find it, which tells me an MRI is not a definitive for diagnosis, but only one tool for pointing to suspicious areas which may or may not be cancerous. And it's possible it could miss it all together. In my case they are calling it confined to the prostate and I decided on surgery after a second opinion at Mayo in Rochester.

Best of luck with your biopsy! I also recommend a transperineal versus transrectal procedure if you have a urologist that can do it. Risk of infection with transrectal is high and I needed a quick trip back to the hospital the next day and an extended stay to recover.

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Part of the biopsy procedure is to do numbing shots prior to taking the actual biopsies. The initial numbing shots are the most uncomfortable part of the procedure. I had quite a few cores taken so asked for an additional numbing shot when I could feel core shots - This numbing shot didn't hurt much at all.
Please note - I have always been horrible with shots, and I went through the biopsy just fine. Mayo-Rochester had a television in the room. I had them put it on HGTV and I talked to one of the nurses throughout the entire procedure - Really helped for me.
Based on my experience, I would not be too worried about the biopsy procedure, it is quick, relatively painless, and provides a lot of data for making your final treatment decision. I agree with some of the other comments - I would not make any final decisions on the MRI scan. This is an excellent tool, but it has limitations. I believe it is common practice to not only biopsy the lesions, but also take random biopsy samples from the peripheral regions of the prostate. In my case, Gleason 4/3 cancer was found away from the MRI detected lesion. I ended up going with a radical prostatectomy on November 3, 2022.
Good luck with your biopsy, and if needed, your treatment decision.

Jim

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I want to double down on the value of a ‘fusion guided’ MRI. That uses prior MRI data and active ultrasound. My home town urologist wanted to do an ultrasound guided biopsy in his office. I don’t know if fusion guided biopsy was an option in our local hospital, then.
I suspect that urologists (read surgeons) are less concerned about a comprehensive biopsy because they do RP (Radical Prostatectomy). If however, one considers radiation (traditional/photon or PBT (proton beam treatment) knowing exactly where there is cancer in the prostate will help to guide the treatment.
Your original question about the likelihood of the lesion being cancerous has a lot to do with your age, history of your PSA, and family history.
In my case I had no family history of prostate cancer, but my PSA had been rising about 1.0 every year. I was 69 when diagnosed. You also didn’t mention if your MRI was an mpMRI (multi-parametric MRI). mpMRI is the ‘gold standard’ for prostate cancer diagnosis.

Wanting to know is understandable. But I’ll caution you to use the delay to research the various types of treatments for prostate cancer. Take a look at the videos at the prostate cancer research institute pcri.org .
You need to be bold and your own advocate (hopefully with a helpful friend/partner).

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@gefears42 You have great advice from @jimcinak. My husband had prostrate cancer, diagnosed in 2003 and surgery in 2004. He researched a lot prior to choosing where to go and what he needed to ask. We live about 55 miles north of Boston and interestingly when we went to a local urologist, at the end of the appointment he said: "of course you are going to Boston for a second opinion I hope!".

We did go to Boston (Mass General) and they were amazing. We were waiting in an office and THREE doctors came in! One was a radiologist, one was a surgeon, and the third was an outcomes specialist. The appointment was fairly long as each talked to us. My husband took the surgical option and all has gone well. If you are concerned I hope you too go to an excellent medical center. It can be well worth the attention you get there.
JK

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