What can I expect after my biopsy?

@ericp502
I am far from having medical expertise but you mentioned you have a Gleason score of 7. Gleason scores come from biopsies and if I read your post right you have not had a biopsy yet. MRI will show areas of concern which normally is followed by a biopsy that will confirm or not confirm if cancer.

I am not sure how you are getting so much information from a MRI. But again speaking from just my own experience with this (MRI, Biopsies, Gleason score, Decipher, PSMA). Right now without a biopsy it would indicae you don't know if you have cancer and could just be BPH. I may have read your post wrong. Have you had a biopsy that gave you a Gleason score of 7.

After you have your biopsy and get your Gleason score then address the treatment options as you will need that to make informed decisions. If you do get cancer diagnosies consider getting a Decipher test and PSMA.

If you don't have trust in your medical providers consider getting a second opinion. They ususally can be done by just allowing your medical records to be given to the other medical provider. Consider Mayo, Cleveland Clinic, John Hopkins and dosens of other experienced and most update cancer treatment instititusions.

Good luck on your biopsies.

Actually with the MRI they can tell if it is a Gleason 7 or above with the images pretty accurately using Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) maps. There are some doctors that think these MRI images and paired with PSMA PET scans could do away with biopsies.

My MRI detected a Gleason 7 or above with a PI-RAD 4 spot. I’m hoping it is wrong but I’ve had two radiologists and Copilot AI look at my images and they all came to the same result. The biopsy will tell for sure and it is next week.

Here is a good article that explains things better than I can.

hxxps://pmc.ncbi.nlm.nih.gov/articles/PMC11162992/

(Remove the “hxxps” and replace with “https”)

You can also just do a google search with the keywords “ mri dwi adc gleason 7” to find this article and many more. There are also many Youtube videos about replacing a PC biopsy with these types of MRI scans.

Again, I hope the radiologists, AI and urologists are wrong but this is what they are telling me right now. Knowing 100% is why I’m doing a biopsy.

For anyone interested this is the full MRI report and I’d be happy to send the images to any doctor on here.

Prostate MRI

PROCEDURE:
MRI PROSTATE WWO CONTRAST 72197
REASON FOR EXAM:
N41.9 hematuria, pelvic pain
COMPARISON:
None

TECHNIQUE:
Multi parametric MRI of the prostate gland performed before and after 10 cc of IV gadolinium contrast. No
contrast waste.

This test is designed to evaluate for clinically significant prostate cancer defined as Gleason 7 are higher including either Gleason 4 + 3, or Gleason 3 + 4 with a significant Gleason 4 component. Patients with Gleason 7 (3+4) cancer without significant Gleason 4 component, Gleason 6 or less prostate cancer are not expected to have significant abnormal imaging findings.

FINDINGS:
RIGHT PERIPHERAL ZONE: No evidence of abnormality or diffusion restriction or abnormal enhancement to suggest clinically significant cancer.

LEFT PERIPHERAL ZONE: Ovoid focus at the lower 3rd peripheral zone measures up to 5 x 3 x 7 mm in largest AP, transverse and craniocaudal dimensions. This demonstrates diffusion restriction and low ADC signal. This does not enhance asymmetrically from the adjacent central gland. No other similar-appearing focus identified.

CENTRAL GLAND: Multiple circumscribed heterogeneous nodules are seen within the central gland most compatible with BPH change (PI-RADS 2-clinically significance cancer is unlikely to be present).

Seminal vesicles: Acutely unremarkable
Adjacent structures/neurovascular bundle: Acutely unremarkable.

Lymph nodes: No adenopathy.
Bones: No obvious suspicious osseous lesions.
Prostate volume: The prostate measures 4.0 x 5.4 x 4.4 cm in largest AP, transverse and craniocaudal dimensions. This corresponds to a volume of 49.76 cc. Calculated maximum expected PSA of 5.97 ng/mL
IMPRESSION:
Suspicious diffusion restricting nodule in the left-sided peripheral zone at the apex. PI-RADS 4

A little bit of a “heads up”. Over the course of 6 years I had 2 MRI’s and two biopsies. My first two MRI’s and my first biopsy were all negative. I decided to go to a new urologist who suggested a second biopsy. It showed two cores of cancer, one at 3+4. I decided on a RP. My pathology report came back with a Gleason 9. Obviously one or both of my recent(2023) prior and post tests were inaccurate. I’m assuming the G9 is correct. Since then I have had 4 PSA tests come back < 0.01. My next test is Monday. Hoping and praying for another undetectable. My advice to you is make sure your tests are accurate. Best wishes🙏

I think a biopsy is an excellent idea. Push for a Perineal one over the Rectal. The perineal can access more areas of the gland and will give you a better idea of what is happening overall - not just in the suspicious area.
Phil

A biopsy is almost literally a needle poking into a haystack.

IIRC, according to Dr Walsh's book, if the biopsy finds anything G7 or above, there's a risk that it missed something worse, which is why it's important to assess risk based on a wide range of factors (imaging, epigenetic testing, PSA rate of change, etc). The biopsy is an essential part of that, of course, but not the whole story.

Thanks for the comment. I opted for the Perineal biopsy and it is next week.

My BPH has been killing me for years to the point it’s affecting my life. I’m already leaning toward removal to kill two birds with one stone.

I'm not a medial professional and have no expertise in this matter. I was 70 in June 2024 when I had NS RARP. I was reasonably fit for my age but not excessively so. I also had BPH, but my symptoms were more mild than yours. I can say my urination is actually better now than before surgery; the flow is great and I empty the bladder quickly. I've mentioned a few times to my wife that that's the one thing in my life that got better after the surgery. Part of my decision process was I asked the surgeon if he thought I was a good candidate for surgery and what he thought my odds were for incontinence and ED for my specific case with him as surgeon. The percentages he gave me were better than I expected and he framed his answer as my status 1 year after surgery. I never had any incontinence although it took me several months to gain the confidence to no longer fear accidental urine releases. I have experienced ED although the sexual function is returning slowly and I can now have intercourse with my wife. Also, the pathology of the prostrate identified both cribriform and IDC, but also indicated it was contained to the prostate. So I'm pretty happy with my decision to have surgery and get it out. Also, all other aspects of my life (sleeping, eating, working out, hiking, etc) have returned to fully normal activities. Of course I have no idea if things would have been better if I'd have chosen a different treatment, but at this point I am happy with my decision. Best wishes.

BTW, my prostate was very large and after removal the irritation from pushing on my urethra was gone.