Serial mpMRI’s

Received my mpMRI results (third in 2.5 years) and met with my new urologist.

This time I received a 3T scan vs the first two which were 1.5T with no endorectal coil.

Amazing as it sounds, ALL three of the originally found PIRADS 3, PIRADS 4 and PIRADS 5 lesions (in the posterior peripheral zones) could not be found!!!

The reaction of my new urologist was "Well...mpMRI's are notoriously inaccurate...."

I said "Well it's interesting that 3 lesions, one being huge (2.1cm x 1.1cm) and the other two (0.9cm and 0.7cm) moderately sized, yet a 3T machine can't even see them 2.5 years later”…..my urologist provided no explanation.

Upon my suggestion, he acknowledged that it’s possible the three original lesions may have been mostly inflammation, especially since the latest 3T scan found evidence of prostatisis.

Anyway, this latest 3T mpMRI found a small PIRADS 4 lesion (11 x 4 mm) only 8% of the volume of my original PIRADS 5 posterior peripheral lesion...in the "left apex anterior central gland, near my urethra".

However, my urologist indicated it’s likely to be a "false positive" because lesions in this area are very rarely aggressive (2-10%)...and then only if they are >2cc...this one is 10x smaller ~0.2cc.

My urologist was amazed regarding my running protocol and demonstration of a VO2 Max increase from 35 to 48.5 in three and a half years (started at 66 y/o and now 69.5 y/o)….see attached.

My urologist felt that cancer research is "just beginning" to learn and understand what cardiovascular medicine has known for decades and indicated that "cross fertilization", where the cancer industry will finally begin a detailed review of the mountains of data generated by all the "heart/lung" experts, via AI and it's ability to find correlations between differing medical specialities.

Bottom Line: My urologist said the only way he could "know for sure" regarding the aggressiveness of the new, much smaller lesion would be to do another biopsy....but he did not recommend it (and said you wouldn't consider it anyway...he was right about that) and said I'll see you in a year after another follow-up mpMRI.

My urologist felt comfortable continuing AS, in my case, because my PSA had dropped and doubling time has increased to 12.3 years (see attached) and PSA density dropped from 0.179 (October 2023) to 0.145 (February 2026).

Has anyone had multiple mpMRI’s (3 or more) and had hard to explain results…in either direction?