MRI Results

This does look good. You Don’t have enough PIRADS Spots to really worry about. The thing is your MRI may not see all of the prostate cancer that could be there. You need to also go by your PSA and its doubling rate as well as the MRI. People have had biopsies that found areas that the MRI never caught.

If your PSA has been doubling at a significant rate then a PSE test could tell you whether or not a biopsy should be done.

PrecisionProstateAssociates.org does an AI comparison
of your prostate MRI with thousands of others.

I am a little unclear on this. You had a biopsy that showed you to be unfavorable intermediate? So likely 4+3 or higher and/or additional grade 3 indications?
If this is the case your MRI is useless from a grading/diagnostic prospective. The MRI can determine, in conjunction with a DRE, PSA and perhaps 4K test if a biopsy is indicated. Once the biopsy is done, that is your diagnosis.
If you did have a biopsy I suggest a second opinion on it along with a Decipher test and given the unfavorable intermediate a PSMA PET.
Good luck with your consults.

Stay Strong Brother, We Got This.

Interesting that you had a biopsy first, and then an MRI. That’s reversed from how it’s normally done.

When they did the biopsy, were the 3+3 and 4+3 lesions they found in the exact same locations that the MRI they did afterwards identified as PIRADS 2?

FWIW, nothing was visible in the prostate on my first MRI in 2021 — it looked perfectly healthy — but the cancer had already metastasised to my spine.

@ebooneac
I agree with others. Get a second opinion, telehealth or otherwise, from a center of excellence, Mayo, Cornell Weill, MD Anderson...and a Decipher test. Also, you may want to ask about spaceoar. If you do radiation, it does create space between your rectum and your prostate which can impact side effects.

The MRI is usually done first and the results are more ‘suggestive’ than ‘diagnostic’.
Your biopsy is the ACTUAL result of what the MRI only suggested - and vaguely at that.
If you have G4+3 unfavorable, the next vital test is the Decipher, which others have already suggested; it will tell you how aggressive your cancer is and it should be treated accordingly.
Remember, Gleason scores are based on the number - amount - of malignant cells relative to others. Your 4 being placed first, means you have more cells of a cancerous type than of a less cancerous type (3). But again, this does not mean more aggressive necessarily.
The Decipher Score (which wasn’t around for many of us a few years ago) IS the test for aggressiveness: it carries a lot more weight than Gleason or MRI and this is what you should really be looking at as you make your treatment decisions.
Just my opinion, not medical advice. Best,
Phil

Consider getting biopsy slides read again by an AI platform comparing them to thousands of others: look up ARTERRA for details. Recently 'approved' by NCCN for diagnostic use. ARTERRA also provides prognostic risk. (based on still historical data sets which may not, of necessity, be as sanguine as a result)
If DECIPHER and ARTERRA line up in their RISK stratifications it certainly will be useful in treatment plans.

Consider also an AI second read of MRIs now renamed 'MALE SCAN' offered through: PrecisionProstateAssociates.org of Kennebunk, Maine. No Phone support ( if Insurance does not cover the test it is about $259.00 but only if the digital transferred file is usable. They seem to be unable to routinely use disks. For those who are planning on an MRI they have a list of devices, criteria (1T, 3T dye or no dye enhanced). Mine was unusable, It is designed to help the Intermediate risk group in the decision process.

I had completely clear MRI with no lesions or suspicious areas uncovered. My urologist did a Free PSA blood test that suggested up to a 50% chance of prostate cancer cells present. He then suggested a biopcy which uncovered two positive cores - 3=4 = 7 (intermediate low risk) and 4 +3 = 7 (intermediate higher risk).

This was followed by a four pronged RO led treatment plan:

- SpaceOAR + gold marker placement (to protect rectum)
- 6 months Orgovyx ADT pills
- 25 daily IMRT radiation treatments
- 1 outpatient high dose brachytherapy "boost"

Now 9 months post treatment I am blessed to report my PSA at .1 and I have virtually no incontinence, impotence, bleeding, frequent urination). Needless to say, I am glad I chose the treatment plan I did and not surgery

Update on MRI Results.

Consulted with Emory Proton Beam Therapy R/O on the 4th. I was extremely impressed with the facility and staff. It is in downtown Atlanta about 1:15 drive in traffic.

Including new MRI data, R/O concurs with intermediate unfavorable diagnosis and recommends treatment.
He ordered a PET PSMA for more info.
Meeting again with the Urologist/surgeon on 20th.
Heavily favoring the Proton Beam Therapy vs surgery at this point. Space OAR and fiducial marker to be used. MRI and CT used before simulation. 28 treatment sessions. Six weeks ADP , recommended, I will decline hormones.

EPBT financial rep called the next day to inform me that Medicare will cover 80% and my Supplement will cover the other 20% less deductible, which means virtually $0 out of pocket.