What can I expect after my biopsy?

One more thing. Whichever treatment path you choose (and especially if you do choose surgery) be sure to educate yourself on "penile rehab". While I've done a couple things I think the daily low dose tadalafil (Cialis) has been the most beneficial for me. I have no idea if you'd even need it nor which treatment would be best for you, but it's something to educate yourself on and plan for even before surgery. When I brought it up my care team was very supportive and helpful. But I was a bit disappointed that they didn't mention it until I asked them about it since in all other aspects I believe my care team was outstanding.

This is the issue I suspect

“Suspicious diffusion restricting nodule in the left-sided peripheral zone at the apex. PI-RADS 4”

PI-RADS 4 means there’s a high chance of it being cancerous. Interesting they don’t say it, but do tell you that’s a high chance.

If you do a Tranperennial biopsy, they should hit That Nodule since It’s probably where they came up with the 7+ number.

I just wonder if that 7+ could mean an eight or nine or is it just a 4+3 and they would’ve said so if it could be higher.

That is the outcome I am hoping for. My BPH is causing a lot of pain in my lower stomach and testicles. I’ve had a bunch of kidney stones and can pass them as large as 8mm. This feels very similar to a kidney stone but the pain is not as intense.

I’ve ruled everything else out. Colonoscopy is good, lower GI is good, bladder scope was good to go. My father is 78 and has had the same BPH issues I’ve had.

To share my experience: I had an MRI to investigate a fluctuating PSA and the MRI showed a PIRADS 4 lesion. I had a trans-perineal biopsy with 4 cores targeted at the suspect lesion and 12 other cores in the usual sampling pattern. Finding from the biopsy was no cancer - just inflammation attributed to BPH.

18 months later I had an ExoDx urine based screening test which indicated a 36% likelihood of prostate cancer. My urologist recommended an MRI which was completely clear; they carefully checked the location of the previous PIRADS 4 lesion and nothing was seen. Despite the clear MRI, my urologist recommended a biopsy 'just to be sure' and I had a saturation biopsy - 24 cores. Two of the cores showed a very low percentage of prostate cancer which I had a prostatectomy to treat.

So my experience has shown that MRI's are not a 100% certain diagnostic tool for prostate cancer especially in cases where there is only a single lesion confined to the prostate. It's important to have a biopsy to follow up on a finding of a PIRADS 4 or 5 lesion to make a complete diagnosis. If your biopsy turns out to show no cancer, it might be good to use one of the newly developed diagnostic tests that go beyond the PSA to look for other biomarkers of cancer. I had the ExoDx; I think another test is the IsoPSA. One of the other members on this forum has a chart that summarizes these tests and shows their accuracy - maybe he will see this post and repost his chart for your reference.

All the best to you as you go through the biopsy and any follow that is needed. This forum is a really great place to get information for the journey - it has been extremely beneficial to me.

I think this is the chart that was being referred to

@ericp502

I would also check out the PSE test from Oxford Biodynamics. It checks a number of bio markers from a blood test that you take with your PSA test and you should get your answer back in a week or two as to whether you were likely to have prostate cancer or less likely to Have Prostate Cancer.

You can also email him. He is a VP in the clinical area of Oxford biodynamics His email address is:Joe.abdo@oxfordbiodynamics.com. Part of the purpose of the test is to take it so that you can then have a better feel for whether you should get a biopsy or not. It also can be used post treatment. It has a 94% accuracy according to Joe and another senior VP, Steve Arrivo at the company.

Thank you. My biopsy is scheduled this next Thursday but I’m going to check on doing this test this week before the biopsy. Won’t give me results to avoid the biopsy but might be another good marker to make a decision.

Thanks @jeffmarc - that is indeed the chart I was referring to.

@ericp502 My 1st piece of advice to you is to EDUCATE YOURSELF , on all aspects of Prostate Cancer , as you are obviously unaware , as we all were at your stage of the journey , of the test procedures and reading their results . i.e How do you get a Gleason Score , and it's NOT from a MRI . Immediately purchase Dr Patrict Walsh's book " Guide to Surviving Prostate Cancer " . It will walk you through all the warning signs , tests , what the results men and your various treatment options , typically, but not 100 % , based on your Gleason Score . Additionally follow Dr . Mark klotz U -Tube Series -- His series will answer most off your concerns .
My 2nd " CRITICAL " piece of advice , and this is covered in Dr. Walsh's book .
Upon receiving your Biopsy Pathology Results -- Get a 2nd and even a 3rd Opinion of your Biopsy slides .
Google : John Hopkins or Cleveland Clinic , plus others regarding 2nd Opinion of Prostatte Biopsy results .
WHY : In my case . MY 1st Biopsy was negative with an MRI RADS 5 Score . Obviously a conflicting result .
My 2nd Transperineal MRI Fusion Biopsy ( same as the 1st ) came back 6 Cores out of 16 Gleason 3 +3 = 6
A 2nd Opinion of these results ALL 6 Cores were upgraded to Gleeason 3 + 4 = 7 - Favourable Intermediate PC
a 3rd and Final opinion was : 4 Cores Gleason 3 + 3 = 6 and 2 Cores Gleason 3 + 4 = 7 .
What did I learn : A Prostate Biopsy is one of the most difficult to diagnose . A breast Biopsy for example is not .
You must find a PATHOLOGIST performing a high volume i.e. On a regular basis , of prostate cancer Biopsy intrepretations . It is not uncommon for pathologists to disagree even witth todays assistance of AI .
John Hopkins as example receive thousands of requests worldwide , for 2nd opinions .
Good luck .
p.s. Do not rush and make a knee jerk treatment decision you may regret the rest of your life . Money spent on Dr. Walsh's book may well change your life -- Money well spent .
p.p.s. With respect to BPH there are many options to treat this condition , WITHOUT removing your prostate Resum being one . I was on Flowmax for several years and have been switched to Dutasteride for the past 5 years . My prostate is 80 cc.

So you are saying the studies, urologists and radiologists that say an MRI can tell the difference between a Gleason 6 and Gleason 7+ (7 - 10) are wrong?

This is from my MRI report. You are saying this is totally false information?

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.