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Not Good News after prostate biospy when MRI didn't look too bad
Last month I had PSA of 5.23 when a few months earlier it was 3.2. Then they scheduled me for MRI of prostate. Did another PSA and it was down to 4.16, but still wanted the MRI. Report is below, doesn't look good PI-RADS 5. At one point they say in report Lesions (PI-RADS 3 or higher). If I understand it, it hasn't spread. Wish I could get a plan with doctor!
FINDINGS:
Prostate measurement: 5.7 x 5.0 x 4.9 cm Prostate volume: 68.75 cc PSA: 4.16 ng/mL PSA density: 0.06 ng/mL/cc
Peripheral zone: See below.
Transition zone: No index lesion. Stromal and glandular BPH nodules.
Lesions (PI-RADS 3 or higher):
Lesion # 1: Location: Left posterior peripheral zone extending from the base to the apex Size: 2.4 x 1.3 x 2.6 cm (5.83 cc). T2: T2
hypointense DWI: Marked restricted diffusion DCE: Focal early enhancement, positive Prostate margin: Abuts the capsule without
definite invasion Overall PI-RADS Score: 5/5
Prostatic capsule: Intact.
Neurovascular bundles: Not involved.
Seminal vesicles: Not involved.
Lymph nodes: No lymphadenopathy.
Bones: No acute osseous abnormality.
Other findings: Small fat-containing right inguinal hernia.
IMPRESSION:
1. The prostate gland measures 5.7 x 5.0 x 4.9 cm with volume of 68.75 cc. PSA density is 0.06 NG/mL/CC. 2. Lesion # 1: PI-
RADS 5 lesion in the left posterior peripheral zone extending from the base to the apex measures 5.83 cc. No frank extracapsular
extension. 3. No pelvic lymphadenopathy.
PI-RADS Category 5: Very high (clinically significant prostate cancer is highly likely to be present)
Really doesn't look to bad, one spot that hasn't spread!
Then Bad Update 2/10/2026
Well got biopsy yesterday and results today, doctor hasn't called, just sent biopsy results to MyChart.
The MRI showed only one Lesion like shown above. Had biopsy done yesterday, they did 3 from the Lesion and 6 from each side of prostate. I wondered why they did more biopsy that were outside the lesion, but didn't ask. Got report today- not good. The lesion look better than areas where MRI saw nothing. They took 15 samples total.
Results:
Final Diagnosis
View trends
A. Prostate, "LLB", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 30% of needle core tissue.
B. Prostate, "LMB", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 70% of needle core tissue
C. Prostate, "LLM", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 60% of needle core tissue.
D. Prostate, "LMM", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 60% of needle core tissue.
Large cribriform glands present.
E. Prostate, "LLA", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 60% of needle core tissue.
F. Prostate, "LMA", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 1 of 1 core, involving 50% of needle core tissue.
G. Prostate, "RLB", biopsy:
Benign prostatic tissue.
H. Prostate, "RMB", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 10% of needle core tissue.
I. Prostate, "RLM", biopsy:
Benign prostatic tissue.
J. Prostate, "RMM", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 50% of needle core tissue
Large cribriform glands present.
K. Prostate, "RLA", biopsy:
Benign prostatic tissue.
L. Prostate, "RMA", biopsy:
Prostatic adenocarcinoma Gleason score 4+3=7 (Grade group 3) in 1 of 1 core, involving 25% of needle core tissue
M. Prostate, "ROI#1", biopsy:
Prostatic adenocarcinoma Gleason score 3+4=7 (Grade group 2) in 3 of 3 cores involving 70% of needle core tissue
Another thread I posted in a person said "You have a Gleason 4+3 7 BUT you have large cribriform and doctors a UCSF say that puts a 5 in your Gleason score." I believe he picked this up from the biopsy report. I don't know what a cribriform even is, it's not mention in report. From googling around it can only be determined by sieve-like or "Swiss cheese" appearance under a microscope and I don't see that in report? But this is all new to me. Doctors haven't talked to me yet, who knows when they will call or make appointment, took long time to get MRI and even longer to get the biopsy done. Sure were fast getting results, they said 7 - 10 days and they gave them to me the next day. Kind of wish they didn't give me results prior to talking with me.
My first thought is just get the thing cut out, not sure how that is done, as seems they got to leave something in there for urine to flow threw. So they couldn't take 100 percent of prostate out. Then I read about nerve sparing or not and not sure what that means. No doctors have discussed this with me yet. Seems if they take it out there shouldn't be any prostate cancer left? But then I read where people get it out and still have a PSA level, so like I said earlier, they must leave some in there, even when they call it total. Had to drive 150 miles to get MRI and biopsy They could have done that in Topeka, but KUMC is ranked as number 50 in top of prostate treatment so I went there Topeka doesn't have a Proton device, that would be back up to KUMC 150 miles RT. One of those radiations therapy is only a few days, not 30 some days. They do have SBRT radiation in Topeka, but I know of someone who had SBRT or maybe it was IMRT and it screwed up several other organs around the prostate, like bladder, kidneys and intestines.
Then some tell me I am lucky to have them all in grade group 2 or 3. But seems like I had a lot of them (12 of the 15) . So I would guess if they did 25 biopsy I could have had more grade group 2 or 3.
All confusing and stressful, other that this I am 78 years old healthy as a horse- no other issues and very active. Loss of what to do and all the different radiation types, that why just getting the pesky thing cut out of there, but seems they still leave some in.
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@jim18
Thanks for the update. After I read the message about abiraterone again I seen the headline on the article was "Six Cancer Therapies Move Toward Broader EU Use". So understand now that it's not new. Got to start paying better attention. If I have to go that route Medicare Part D has a cap of what I have to pay a year.
@diverjer
Abiraterone Mylan It’s just a generic version of abiraterone And acts no different from the original drug.
It is recommended that people start with abiraterone Before moving on to a lutamide. It is a lot harder around the body, and if you have heart issues can really aggravate them.
I was on it for 2 1/2 years and it gave me high blood pressure and five afib events. I know people that have been on it for five years and had no problems at all.
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3 ReactionsGot written plan from KUMC, seems to mention bad things in pathology, but not the few good like margin was a single <3mm. Sure am mad at my PCP who ignored my PSA increase on 2/10/23, I think that is when it was started and more manageable, but PCP ignored my request for referral to urologist. Then I guess stupid me for not ignoring PCP and just going, but I trusted his decision. I asked, said this jump wasn't good, but he ignored me as being overly concerned over nothing. Said less that 4 you are good. Other reading this learn from it, that was too big of a jump.
Assessment and Plan:
Jerry is a 79 y.o. male with history of diagnosis of unfavorable intermediate risk prostate cancer. He had PSA rising up to 5.23 on 12/16/2025. He underwent radical prostatectomy and bilateral pelvic lymph node dissection on 4/30/2026 ( ALL 10 NODES WERE NEGATIVE). Final pathology prostate adenocarcinoma, gleason 3+4=7, with positive left posterior margin, left seminal vesicle invasion, non-focal EPE at the left posterolateral neurovascular bundle, LVSI present, pT3bN0.
We discussed the role of adjuvant vs salvage radiation therapy in the management of patients with recurrence after prostatectomy. Indications for adjuvant radiation t herapy include adverse pathologic features such as pT3 or positive surgical margins which were present on Jerry’s pathology. There are multiple retrospective studies have demonstrated improved survival with salvage radiation therapy in patients with biochemical recurrence of prostate cancer after radical prostatectomy. We also discussed the benefits seen with the addition of pelvic nodal irradiation based on the results of the SPPORT trial (Pollack, Lancet, 2022). He has a good performance status (I NEED TO ASK WHAT GOOD PERFORMANCE STATUS MEANS) and we could consider including the pelvic lymph nodes. We explained that this may come at the cost of increased toxicity. Our plan would be to treat the prostate bed to a dose 66 Gy in 33 fractions, and we could consider treatment to the pelvis to 46 in 23 fractions. (SHE DIDN'T SAY IF THEY WOULD DO THESE ALL AT ONCE OR 33 THEN ANOTHER 46 FOR TOTAL OF 79 SESSIONS)
We reviewed the potential side effects associated with radiation therapy. These include urinary symptoms (increased urinary frequency and urgency, dysuria, and obstructive symptoms), GI symptoms (loose stools and blood in stool), and sexual dysfunction. However, urinary incontinence is relatively uncommon after radiation treatment.
We also discussed the potential role of the addition of ADT with the patient. Multiple trials (RTOG 9601, Shipley, NEJM 2017. GETUG-AFU 16, Carrie, Lancet, 2016) have demonstrated a significant improvement in freedom from progression, with RTOG 9601 demonstrating an improvement in overall survival and prostate cancer specific survival with the addition of ADT. We recommend the addition of 6 months. Given that he continues to have improvement in his urination and low PSA at 0.06, I would recommend continued monitoring of his PSA every 3 months. I would initiate ADT (DIDN'T SAY WHAT KIND OF ADT, WELL MAYBE MENTION SOMETHING THAT STARTED WITH LU) when his PSA rises to 0.1, and evaluate his urinary control. Should his urinary symptoms improve and plateau we could initiate radiation therapy.
Follow up in 3 months after his next PSA
Katelyn Kane, M.D.
Department of Radiation Oncology
I personally spent over 30 minutes for face to face counseling, discussion, care coordination, documentation, and medical record review.
PSA history:
8/19/2026 0.06
6/11/2026 0.06
1/12/2026 4.16
12/16/2025 5.23
1/28/2025 3.24
6/4/2024 3.27
2/10/2023 3.30
2/11/2022 2.29
@diverjer The RT would be 23 with a wider field that included the pelvis and another 10 concentrated on the prostate bed so 33 total. Lu-pron (ring a bell)? That could be a 3 or 6 month shot. Most have fewer side effects and better recovery with Orgovyx. The fractions are 2 Gys per treatment so 66 Gys in 33 treatments to prostate bed.
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6 Reactions@jim18
I did mention that there was a pill I heard about that had less side effects that started with letters "or" and she said the name and seem to be okay with it. I still praying for no reoccurance so I don't have to make all these decisions,
@diverjer Monitor the PSA and do what you have to do - no decisions necessary…
She laid it out very clearly concerning your positive margin and seminal vesicle invasion.
The RT is very standard now - bed and nodes - and ADT for 4-6 mos to enhance success.
Believe me, your surgery, with its many complications and SE’s, was probably worse than SRT…don’t worry!
Phil
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3 Reactions@diverjer
I wouldn’t bet money on the fact that the Orgovyx Pill will have fewer side effects. It will not cause plaque built-up in the arteries, like Lupron can do. And when you stop it, your testosterone will come back much quicker than the other drugs. The side effects are caused by low testosterone, not the drug itself.
The plan you describe sounds reasonable, but one recent study I read about said that 80 Gy Ended up with better results than less radiation. Could be that’s just related to the initial treatment not the salvage radiation treatment. I would at least ask the doctor about it.
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2 ReactionsInteresting never hear of endorectal balloon for salvage treatment. Has anyone ever heard of this endorectal balloon? It's mention in this article:
https://www.medscape.com/viewarticle/can-accelerated-salvage-rt-improve-prostate-cancer-control-2026a1000u00
@diverjer Yes - The use of endorectal balloons was common for primary radiation treatments prior to 2015 (when the SpaceOAR Hydrogel rectal spacer was approved for use).
They found that SpaceOAR offered improved benefits when compared to the older endorectal balloons: https://www.urologytimes.com/view/hydrogel-spacer-lowers-rectal-bleeding-vs-balloon-immobilization-treatment
The problem with using endorectal balloons for primary radiation treatments is that the anterior wall of the rectum is left fully exposed to radiation; in addition, the balloon has to be inserted and then removed at each treatment. (Sounds pleasant doesn’t it?) Whereas the rectal spacer is injected just once, and lasts beyond the entire course of treatments.
All that is the same for salvage radiation treatments (which can be post-prostatectomy or post-primary radiation).
Though uncommon, there have been a few studies regarding the use of rectal spacers for salvage radiation post-prostatectomy:
> This from a 2024 paper: https://www.mdpi.com/2563-6499/5/2/20
> this from a 2015 paper: https://pubmed.ncbi.nlm.nih.gov/25339311/
> this from a 2019 paper: https://medcraveonline.com/IJRRT/IJRRT-06-00224.pdf
If I were looking into salvage radiation post-prostatectomy, I would at least ask about endorectal balloons (& possibly about using a rectal spacer).
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