MRI of Prostate... Lesions

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skelly31
skelly31 Member Posts: 13 Member
edited May 2022 in Prostate Cancer #1

I had an MRI in beginning of 2018... 1 lesion was found... and multiple nodules (PI-Rads 2)

MRI at end of 2021 stated, "No nodules found" (PI-Rads 2)

I have BPH (143 gm up from 99gm in 2018). My last three PSA's were 6.4, 7.43, now 8.8.


Do nodules and Lesions "go away"?

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  • Rob.Ski
    Rob.Ski Member Posts: 155 Member
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    Have you had a biopsy? They are more informative than MRI.

  • J69
    J69 Member Posts: 35 Member
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    Shelly, I agree with Rob, with a rising PSA a biopsy might answer your question. What does your urologist suggest? If you are having urinary problems due to your high BPH, he might recommend a TURP operation to help. However, in my case that made taking out the prostate a little more tricky. It also may eliminate some treatments should Prostate Cancer be found.

  • skelly31
    skelly31 Member Posts: 13 Member
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    Thanks, for the responses.

    I've had three biopsys.... 2017 (Gleason 6 in 5% of one core) 2018 (Nothing Found) late 2019 (Gleason 6 in <5% of one core)....

    I'm near the 5 year mark and due to have my "5 year Biopsy" in six couple months.

    PSA has been rising (slowly?) From ~3 in 2017..................... to 8.8 now


    Urologist #1 says to get a PET-Axumin scan (He's an oncologist concerned with age PSA trend and family history.

    Urologist #2 suggest the MRI and says keep the Active Surveillance protocol.


    The fact that MRI 1 showed nodules and 1 lesion and MRI 2... with a much less detailed summary report says nothing found...this has me puzzled.

  • Rob.Ski
    Rob.Ski Member Posts: 155 Member
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    I had 2 MRI's that showed nothing when biopsy confirmed gleason 6. I think the gleason 6 is harder for the MRI to pick up. My third MRI just before my surgery showed PIRAD-4 lesion. Pathology after surgery was 3+4. If you dig around on this site, I think people have had PIRAD-4 lesions that are benign so, I don't know how much to let the MRI influence your thought process. We want as much info as possible to make most informed decisions but, not all info is the same.

  • centralPA
    centralPA Member Posts: 311 Member
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    What was your 99gm PSA as compared to your 143gm PSA? Were the densities the same?

    You would expect a 40% increase in PSA with the 40% increase in mass.

  • VascodaGama
    VascodaGama Member Posts: 3,692 Member
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    Do nodules and Lesions "go away"?

    Hi again,

    The interpretation of the MRI film into nodules and lesions depends on the experience of the radiologist, and the way in reporting the results are not standard.

    When taking the second MRI, the radiologist commonly uses the results of the previous scan and adds only what is new. They do not get a second look on the first film to compare.

    If worried about the last results, you can try requesting second opinions on the films from the three scans at an independent radiologist.

    I am curious about your history. I wonder what led your #1 urologist be concerned with your age and family history. How old are you? Do you have family members with PCa diagnosis?

    The size of your gland is about 5 times bigger than the normal of 25cc (up to 55 years old), ou 40cc for a 70 years old. The traditional biopsy template of 12 needles could easily miss regions of concern. It is, therefore, wise to discuss with the urologist in advance on the method he will adopt in your next biopsy. Probably deviating some needles to other regions of the gland or using the 14 needles template.

    There is no doubt that AS is the best option if the status of the person/patient so permits it, however, AS is not a walk in the park. One must be strong mentally to live with the bandit under the same roof.

    I think it better for you to keep your inquiries/reporting in one same thread if interested if getting better concise opinions.

    Best wishes

    VGama

  • skelly31
    skelly31 Member Posts: 13 Member
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    I'm 58 now. Was diagnosed when I was 53. My 69-year-old brother was diagnosed with Gleason 3+4 about 7 years ago.

    Thanks for your input.

  • skelly31
    skelly31 Member Posts: 13 Member
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    Yes, densities are about same. .0425 to .051 range. The percent of increase of size of prostate matches percent of increase of PSA values from 2019 to 2021 (Is the correlation between percentages of increase in PSA and size normally linear in nature?

    Jan 2018 Aug 2019 Nov 2021

    88gm , 3.74 PSA 99gm , 5.14 PSA 143 gm , 7.4 PSA

    (If I use just the 2018 and 2021 values... 63% increase in size but 98% increase in PSA)

    Linear regression on all three data points gives an r value of .98..... strong correlation between size and PSA value.

    Does correlation equate to causation ?

  • Clevelandguy
    Clevelandguy Member Posts: 1,084 Member
    edited March 2022 #10
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    Hi,

    If I was in your shoes I would go with the PET scan that Urologist #1 suggested. The PET scan could possibly show something that the MRI did not pick up. The PET if done before the biopsy might give the Urologist areas to sample from. Both of these might give you a clearer picture of whats going on with your Prostate. The BPH does nothing but also cloud the picture of your specific case. Good luck……

    Dave 3+4

  • centralPA
    centralPA Member Posts: 311 Member
    edited March 2022 #11
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    It definitely is capable of explaining the PSA increase.

    I have a 140cc prostate with BPH symptoms, and a 3+4=7 biopsy. In talking with the uro, he mentioned how big prostates and bad cancers don’t usually go together. It’s the smaller prostates that throw the curves. I found that anti+correlation to be nice to hear.

    I also had the genomics test on my biopsy result, which indicated reduced probability of mets. Additional good info.

  • skelly31
    skelly31 Member Posts: 13 Member
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    Dave and central IPA,

    Great info, thanks for the info... and advise too on the PET

  • skelly31
    skelly31 Member Posts: 13 Member
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    I'm scheduled for the PET Axumin scan.... Are there any negative side effects associated with the Axumin dye?

  • skelly31
    skelly31 Member Posts: 13 Member
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    How effective is a bone scan in detecting the spread of prostate cancer?