MRI PIRAD 4

Rob.Ski

So, I had been on active surveillance for over a year, second biopsy back in May 2021 was all gleason 6 with a couple of high volumes. To date, nothing had shown on two previous MRI(s). I decided to proceed with treatment back in November. RP was scheduled for 1/25 (doc pushed to 2/15). Got another MRI recently with the following results:

PIRAD 4

T2-Weighted Images 4

Diffusion Weight Images 4

Size 11x3

Level of Prostate Midgland

Zone Peripheral

Extra Prostatic Extension - Abuts capsule without visualized EPE

Additional Peripheral Zone - Diffuse decreased T2 signal bilaterally, possibly inflamatory

Additional Transition Zone findings - Enlarged and Hetergeneous in appears, consitent with BPH

Seminal Vesical Invasion - no evidence

Neurovasuclar Bundles - unremarkable

Lymph Nodes - No pathological pelvic lymph nodes

Ossesous Structures - no aggressive osseous lesions

Impression: Stable 11x3 mm right posterolateral midgland peripheral zone lesion, PIRAD 4, high

So, now seeing lesion on in MRI on outer edge and am wondering if this should impact decision on RP treatment. Have yet to speak with doc, just the nurse practitioner that said they wouldn't know escape until pathology on removed gland.

Rob

eonore

Rob,

Had you consulted with a radiation oncologist before making your decision for RP? And why did you choose RP over radiation?

You have raised a good question. You need to discuss these findings with both your surgeon and a radiation oncologist. I can tell you, having had both surgery and radiation, if I had the option, I would take radiation every time. That’s just me.

VascodaGama

Though the T2W finding refers to the peripheral zone (PZ), the MRI report doesn't indicate existing extraprostatic extensions. It says that the pirad4 borders the shell. Surely the matter is for concern if in fact the image refers to cancer. Probably RT would be a better choice.

In any case, a decision on treatment based on an MRI result is always ambiguous as we know that decreased signal on T2W images are also demonstrated in post-biopsy hemorrhage, prostatitis and hyperplastic nodules/calculi, apart from prostate cancer.

Take your time to investigate and discuss further.

Best wishes

VG

Rob.Ski

I've talked to 2 radiologist and 3 surgeons and all of them recommended surgery mostly because of age, 51. Everyone is hedging on options if surgery fails.

VascodaGama

Rob,

You are the leader of your case. Those doctors you consulted only suggested recommendations. At the time of the treatment you will be requested to sign an agreement in advance relieving any responsibility on the outcome.

That opinion that surgery is proper for young PCa patients is false. You need to consider, not just cure but the risks and side effects you will endure for life. These are cumulative at each intervention.

I wonder about the location of the positive cores of the last biopsy. I recall these representing a high voluminous Gs6 cancer which could justify dissecting the whole gland but that may signify existing EPE.

https://csn.cancer.org/discussion/323445/biopsy-results#latest

Remember that both, surgery and radiation can achieve the same results in contained cases. Radiation may be more appropriate if localized metastases exist. Choose what gives you higher confidence and discuss the pros and cons with your family.

Best

VG

Rob.Ski

Both surgery and radiation can achieve the same results, both can also fail as treatment. I made the decision to give myself better options if first treatment is unsuccessful. It was a hard decision to make, not looking forward to the whole thing. When I made the decision, I was ready then, not thrilled waiting 3 months. Now I get another piece of info just prior that adds a little doubt to the decision.

centralPA

Was the technology for all of your MRIs the same? Seems hard to go from nothing to a clear signal.

I'm a newly diagnosed 3+3=6 myself , so tracking your case. Thanks for sharing.

Rob.Ski

T3 MRIs all at the same place. Second biopsy came back with 3+3 but, higher volumes so, things seemed to be progressing. PSA been creeping up as well over past 2 years.

Clevelandguy

Hi Rob,

Sounds like with what you describe either surgery or radiation might benefit. Surgery could be a good choice if the cancer has not escaped the gland with radiation as a good follow up if needed. That was my way of thinking when I had my surgery but the choice is up to you. Both treatments could have bad side effects depending on the skill of the surgeon and equipment and progression of the cancer. Might benefit from a second opinion from a different hospital network? Sounds like the horse is getting ready to leave the barn so if it was me I would not wait to long. There is no right or wrong choice, radiation or surgery, just the best one that fits your goal of getting rid of the cancer base on all the factors of your specific case and medical consultations.

My3+4 was getting ready to leave the barn,(pleural neural invasion), glad I didn’t put off my decision for months.

Dave 3+4

Old Salt

Good summary from Clevelandguy.

You do have about three weeks to decide whether surgery is the best choice for you. Not easy, but others have said to not look back once you have made a decision

centralPA

On your two previous MRIs and having them be "nothing shown", I would be curious to have those two imaging sets read by the same person (was it the same person?) who read your third one that showed PIRADS 4. That just strikes me as curious. Don't know if it is doable or not.

But...it is what it is, and sounds like you've got the plan to deal with it. Best of luck!