Serial mpMRI’s

My husband's "original" lesion shrunk in size over the years and guess what - it contained aggressive cancer. I am saying this just as a cautionary tale for other members here - unless you have a biopsy you have no idea what is going on and even than, you will have just "some" but pretty good idea after the biopsy since it samples just 10% of the whole gland.

Handera - I am wishing you all the best : ))) ! May your case be completely different : ))) ! After all, your lesions dispersed completely : ).

@surftohealth88

Thanks for the good wishes!

I fully understand your cautionary note.

I obtained a Decipher score of 0.22, along with a low volume Gleason 3+4 pathology report and the ERASE randomized clinical trial protocol I embarked on IS designed for someone with “Low Risk” localized PCa, on active surveillance.

I fully realize new (and worse) cancerous lesions are always possible and I’m not recommending my particular protocol to anyone….everyone needs to do their own homework and, in conjunction with their doctor, decide what is the best treatment in their particular situation.

As far as my situation is concerned, I’m quite convinced (after 1300 hours of research, 2.5 years of protocol implementation and a history of clear, measurable results) that this is working for me.

For example, regarding heart rate reduction during HIIT runs over time, my average heart rate has dropped from 182 bpm (March 2023) to 130 bpm (August 2025) to stay at the same 0.25 mile HIIT running pace.

Obviously, my heart and lungs have strengthened significantly.

Hopefully, those with low risk PCa can look into these matters themselves and decide, with a physician’s advise, if any of this is of interest for their situation.

@handera Congratulations! I've only had two MRI's in 2025. First was Pirads 3 (one lesion) and second was Pirads 2 (no focal lesion) and some indication of BPH and Prostatitis. Currently on Tamsulosin which is doing its thing. PSA has fluctuated between 8 and 4. Most recently 6. Prostate volume went from 95 ml to 70 ml. I'll do another PSA in March. But for now tracking all the metrics, running, drinking unsweetened cranberry and eating broccoli sprouts. Hoping for some PSA stability.

@handera We live in a technological age of testing, scans, numbers and scores.
One hundred years ago when none of this was available, men walked around with prostatic lesions - some totally benign, some so-so, others a bit more feisty, and yes, others that would grow, spread and kill them.
None of that has changed one bit.
I think your training regimen and better fitness level is terrific! It’s a lot of hard work and requires discipline and sacrifice. I would say that all these improved numbers are a result of that hard work.
But how can anyone EVER know if your original lesions with the higher PIRADS scores would have ever amounted to anything more than diffuse PIN or BPH? Who knows if that small G3+4 was destined to go onto anything more aggressive than the original ‘low risk’ category?
I guess what I’m saying is that ultramarathoners get deadly PCa, couch potatoes get it too. Meat, egg and dairy eaters get it, but many, many don’t…it’s a riddle inside an enigma! Don’t think it will be solved in our lifetimes.
Meanwhile, congratulations on your recent results and best wishes for staying on ‘that side’ of the forum!
Phil

Yes, it is possible that “… mpMRI's are notoriously inaccurate...."

Remember that a PIRADS score is just one specialist’s educated, experienced opinion of what is seen in the scan image - one might see a PIRADS 3, another might see a PIRADS 4 - much of the interpretation of scans and images is as much an art as it is a science; there is no way to know for certainty which one is “right.” That’s why 2nd opinions are always recommended for any test result that requires an opinion of interpretation.

Besides just PSA and MRI, have you had any other confirmation tests to determine if a biopsy is warranted?

@brianjarvis

Agree with your statement (and my urologist’s comment) regarding the inaccuracies of mpMRI's. In fact, I would broaden that statement to include ALL PCa related tests and procedures….including all the new urine and blood biomarker tests AND even biopsies themselves!

For someone diagnosed with low risk PCa, the ONLY thing that really matters are TRENDS...where one compares “apples with apples” the results of repeated tests, calculated parameters and biopsies.

I’ve had 3 mpMRI’s, 9 PSA tests and one biopsy over the last 2.5 years.

As of today, my trends include:

1) Post biopsy PSA doubling time (over 2 years and 9 PSA measurements) of 12.3 years.

2) PSA Velocity of 0.255 ng/ml/yr between Feb '24 and Feb '26

3) PSA density = 0.179 (10/23) at diagnosis, 0.157 (10/24) and dropping to 0.145 (02/26) most recently.

4) mpMRI results:

(10/23) - Volume: 43.5cc, 3 posterior peripheral zone lesions (2.1x1.1cm, 0.7cm, 0.9cm), moderate abnormal DWI/ADC signaling, largest lesion suspicious for mild local EPE. CONCLUSION: PIRADS 5, PIRADS 4 and PIRADS 3 lesions in the posterior peripheral zone, with indistinctness of capsule raising suspicion of extraprostatic extension only for the PIRADS 5 lesion, no evidence of seminal vesicle invasion or pelvic metastatic disease.

(10/24) - Volume: 43.3cc, 1 posterior peripheral zone lesion (1.9x1.1cm), the other two posterior peripheral zone lesions not visualized, mild abnormal DWI/ADC signal for the one posterior peripheral lesion (not given a PIRADS score), mild local extraprostatic extension not excluded.
CONCLUSION: stable posterior peripheral zone lesion, previously seen peripheral zone lesion not visualized, no new suspicious lesions,

(02/26) - Volume: 44.6cc, all original peripheral lesions not visualized, but diffuse strained appearance of peripheral zone may reflect prostatitis, 1.1x0.4cm left apex, anterior central gland near urethra, extraprostatic extension is highly unlikely (rated 1 out of 5). CONCLUSION: PIRADS 4 lesion measuring 11mm x 4mm centered at the left apex anterior central gland with no evidence of extra prostatic extension, seminal vesicle invasion or pelvic metastatic disease.

My urologist's recommendation, based on my trends, including my 0.22 Decipher Score and his knowledge of the location of this latest mpMRI lesion, was that another biopsy was not necessary, at this time, and to continue monitoring.

We did discussed the use of the newest MPS2 test; which I will request in the future, before undergoing another biopsy. MPS2 has an incredible NPV of 99% for GG3 or higher cancers and detected 94% of GG2 or higher cancers.
https://www.urologytimes.com/view/mps2-test-validated-for-detection-of-high-grade-prostate-cancer-in-non-dre-urine

@heavyphil

Thanks for the good wishes!

You're right, most of life is more accurately portrayed as a series of anomalies.

...so here's to "What's next!"

All the best!

My thumb rule: Always get second-opinions for any chronic diseases, which cancer is one of them. My husband's urologist told him that the lesions with any PIRADs should warrant the biopsy. It can be benign, or it can be cancer. We never know until it's evaluated. Besides, if it's cancer, they want to know whether it's high risk or aggressive. My husband got 3T MRI which show one big lesion and one small lesion, both with PIRAD 4. I'm thankful that his urologist pushed him for biopsy because 5 out of all cores contained cancerous cells: 4 with Gleason 7(4+3) unfavorable and 1 with Gleason 8. Therefore, my husband's cancer is deemed high risk and require immediate treatment, rather than waiting. Had we not know this, we would still wait and see. Thankfully, we didn't. My husband got prostatectomy, which found very tiny trace of cancer cells in the right seminal vesicle, so his stage was upgraded from 2T to 3Tb.

@handera, do you know if the MPS2 test is similar to the PSE Episwitch test? Neither seems to be part of the standard of care protocol but both seem to be more accurate than a PSA test. Were your Free PSA numbers in the 10%-25% range or higher or lower?

@ezupcic

PSE is also a very promising biomarker test. IMHO, based on my research, it receives a silver medal to the MPS2’s gold medal….at least at this point…

Never had the “free” PSA test.

Remember my urologist comment and my broadening (based on my erroneous initial biopsy result and 1300 hours of research):

ALL PCa tests are “notoriously inaccurate”…the most important thing (AGAIN ONLY FOR THOSE DIAGNOSED WITH LOW RISK PROSTATE CANCER ON AS) is the TREND…in other words I put no stock in one “free” PSA result, mpMRI result or even a biopsy result….but what is the TREND of multiple tests indicating?