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Conflicting PI-RAD and Prolaris results

Posts: 3
Joined: Jun 2021

I have been diagosed with Gleason 3+4=7 PCa with a PSA of 5.9 and a normal DRE (T1c).  I am 71 years old.  My PI-RAD score was a 5 with a small, localized tumor found.  My MRI-guided biopsy showed 34% positive cores.  Since this put me in a favorable intermediate classification my doctor ordered a Prolaris genomic test.  It resulted in a molecular score of 2.9 which tends to favor Active Surveilance.  All that sounds good, however in subsequent reading I see a lot of studies that indicate a PI-RAD of 5 is quite often indicative of an upgraded Gleason score and/or a lesion that is beyond the capsule.  So, I have two contradictory test results: a favorable Prolaris score and an unfavorable PI-RAD score.  Is anyone aware of any studies that could help me resolve this issue?  My doctor seems to think that Prolaris is the only determing factor and that PI-RAD has nothing to do with my decision.  I am very dubious about his conclusions.

hopeful and opt...
Posts: 2336
Joined: Apr 2009

A pirad of 5 indicates that a significant cancer of 3+4 or greater is very likely. It does not indicate that the cancer is outside the prostate. Apparently the MRI that you had did not indicate extra capsular extension. 

If you have a small amount of 3+4 then you and your doctor may wish to consider Active Surveillance. 
Since you had a fusion biops, at a later date your doctor can survey the area around the 3*4 to determine how extensive the 4 is, if any 

At this time I would consider having a second opinion on the pathology by a world class pathologist. All treatment is based on the findings of your pathology. 



VascodaGama's picture
Posts: 3407
Joined: Nov 2010

I agree with Hopeful's comment above. You should focus on the biopsy results to make a decision. Both; pirads and prolaris are simple tests that only predict the status. The biopsy is the real thing. The number of positive cores and their location can give you a better picture of your status.

I am curious about your T1c clinical stage. Surely the negative DRE sets the case into a T1 but a MRI guided biopsy sets the case into the group of T2 because cancer can be identified in the image study. The possibility of being a T3 (EPE) can be predicted by the location of positive cores.

I think that AS is the best approach to handle a PCa diagnosis but one should try all means to be certain that his case is contained and none aggressive. 

Best wishes and luck in your journey.


Old Salt
Posts: 822
Joined: Aug 2014

That the doctor gave you erroneous information.

The biopsy result is WAY more relevant to your situation. I hate to write this, but it appears to me that treatment will be in your future. 

Good luck deciding which approach would best suit you.

Posts: 704
Joined: Jun 2015


I think Vasco said the magic word, location.  I would want to know if the tumor was deep within my Prostate or close to the edge.  If it's deep within then you have time to go AS and monitor.  If it's close to the edge of the gland you might want to take  care of it sooner so it does not escape.  Your choice, your body.  My cancer was very close to escaping, glad I had mine removed when I did or I would be in a totally different place today.  Just my opinion and you know what they say about opinions LOL.......

Dave 3+4




Posts: 2
Joined: Jul 2021

biopsy gleason score is often lower than true 

mine was 3+3 but i opted to have another biopsy done which returned

3+4 and i opted to have my prostate surgically removed

and it was found to be 4+3 after the operaton

there was a palpable lump on my prostate at the time

psi was only 4

after surgery it went down to 0.02 and after savage radiation down to 

undetectable and has been that way the last 8 years


and after surgery 

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