PSA/MRI not too bad, Biopsy not too good. What??

I also had pirad 3 MRI even though my tumor in the end was 3+4. If the biopsy shows a tumor that is what you should go by.

Given the extent of the tumor, you will likely want to treat it. Your next steps will likely be Decipher and/or Artera AI. A PSMA may not be necessary with a 3+4 (and probably not covered by insurance). Given your family history, I would also do a genetic test to check if you have BRCA or ATM mutations.

Your situation really is an issue.. In a recent PCRI conference one of the doctor said that if your biopsy shows more than five cores with 3+3 or more than it should be treated.

I count eight cores with 3+3 or 3+4.

Apparently, you only counted the below as one core when it’s actually shows 3 of 3 cores affected

Right Posterior Lateral: 3+4, % of pattern 4 is less than 10%, "tumor involves 20% of overall specimen (3 of 3 cores). Most affected core involved by tumor over 40% of its length"

The one above it showed only one of two cores affected.

This means you have four cores with a 3+4 and some of them have a significant amount of tumor.

I’m sure that doctors at Mayo Clinic Rochester will note this, and want to start some sort of treatment.

PIRADS 3 Is not considered cancer, but you seem to have enough 3+4 cores to confirm a cancer diagnosis. Of course you need to leave the final decision up to the doctors.

My MRI showed no concerns in my prostate (which was normal size), just the metastasis on my middle spine. We didn't even know it was of prostatic origin until after the biopsy results came back.

The biopsy is one of the two most important things. The other is a PSMA Pet scan. I would suit up to get treatment and get the PET scan before you initiate.

I did the Color/Promise Registry genetic testing (saliva test) and it found no hereditary cancer risks at all, the tests included ATM, BRCA1, BRCA2. Will talk with Mayo team, but seems like it's time to treat. It is what it is. Thanks for the feedback!

Thanks, Jeff! I cannot understand why the biopsy NP knew to get multiple biopsies from Left Interior Medial, if the MRI Radiologist report only showed a tumor in Right Posterior Lateral. Of course, very glad she did. But wondering if she could see tumors on MRI during biopsy that were not noted by Radiologist?

Wow, that is unexpected. Thanks for letting me know!

Yeah, wish there was one and only one path of treatment, not easy to make a decision. But expecting the Mayo team will guide me through it. Thanks for the advice about PET scan, will see if I can get it for sure.

In one of his presentations, Dr. Kwon (of Mayo Clinic) indicated that an insurance company review of all their prostate cancer treatment records showed 2,200 different treatment combinations that Mayo Clinic had used, He himself questioned whether even their doctors really know all they say they know.

He recommended, learning all you can about your prostate cancer and treatments, and then self-advocating and share in the decision-making.

The MRI probably didn’t miss it. Much of the interpretation of images, scans, and slides is often as much an art as it is a science and dependent on the skill and experience of whoever is doing the reading. This is why a 2nd opinion is often recommended for any decision requiring a physician’s interpretation or opinion.

Fortunately, a 3+4 (intermediate favorable) with a small % of “4” cell type and no other significant risk factors is very easily treatable with good outcomes.

You’ll do fine.