Need advice

alexrtk

I am 71 years old. For the last 3 years my PSA fluctuates between 3.8 and 5. Last PSA was 4.9 in January 2024.

On February 28 had mpMRI. The results are:

IMPRESSION:

Prostate hyperplasia

PIRADS 2 - Low (clinically significant cancer is unlikely to be present).

Nonspecific bilateral external iliac adenopathy (1.0 cm short axis)

My urologist told me that the test is negative and I don't need to proceed to biopsy.

My concern is adenopathy and I already scheduled an appointment with a hematologist/oncologist. 

What is your advice?

centralPA

I’d get a second opinion of the MRI from another radiologist first. Interpreting them is an art and a science.

alexrtk

Thank you for your advice.

How to do it? I think, first of all I should take a disk with MRI images, but what is next?

centralPA

https://csn.cancer.org/discussion/comment/1714120#Comment_1714120

I got a second opinion on my biopsy, not my MRI, but if you google on "MRI radiology second opinion prostate" you'll see all kinds of options. Stanford and Mass General both popped up as offering services, along with others. Just click and follow the instructions.

I think the best path is one where your doctor sends the records to the 2nd Opinion Folks for a consultation. Plan B is is you get the image files (I did) and send them separately. But Plan A is better.

This article talks about hard evidence suggesting 2nd opinions...

Conclusions

Second reading of prostate mpMRIs by subspecialised uroradiologists significantly improved the positive predictive value for detection of clinically significant prostate cancer and showed a trend towards improved NPV for MRI-negative cases where biopsy could be safely avoided. Urologists should be aware that the experience of the reporter will affect the report when making decisions if and how to obtain biopsies. Reporter experience may help to reduce overcalling and avoid over-targeting of lesions.

centralPA

Left out the link in my last post. Google on an article titled "Comparison of initial and second opinion reads of multiparametric magnetic resonance imaging of the prostate for transperineal template-guided biopsies with MRI-Ultrasound fusion"

alexrtk

Very useful article. I found that negative MRI (PIRADS 1-2) in the 2nd read were compatible with the 1

alexrtk

Very useful article. I found that negative MRI (PIRADS 1-2) in the 2nd read were comparable to the 1st read:

"The number of negative mpMRI second reads was comparable to that of the reports (55% vs 50%, respectively) , and resulted in a similar NPV for GS ≥ 3+4 cancer for both second reads (0.93; 76/82) and initial reports (0.88; 64/74); P=0.291 . NPVs for higher grade (GS ≥ 4+3) tumors were also comparable at 0.92 (78/82) and 0.95 (68/74), respectively; P=0.519. Initial reads had 4 more false negative results compared to the second reads"

centralPA

In your case, it is all about those lymph nodes. Getting a second look at them is the main goal (I think!)

Wheel

an appointment with a hematologist/oncologist is a good step. They can run specialized blood tests for a blood cancer. The size of the lymph nodes are small. Under 1cm they often don’t even report, and if that size or up to 2cm then they might just describe as mildly enlarged. They could be from enlarged for any number of reasons. I think they will order some blood tests, and from there decide on whether to proceed with a CT scan of Chest, Abdomen and Pelvis (standard for blood cancers) and see if any other nodes are swollen. I doubt they would needle biopsy such small nodes. The size of the node might not mean anything. If they did do a CT scan of you and found multiple larger nodes then they would likely do a needle biopsy which is easy for an accessible lymph node. Then also maybe a bone marrow biopsy. If there was nothing abnormal about your blood work they could just have you back for blood work in 6 months again and no scan. If they did a scan and it came back to show just those same nodes and nothing else, and nothing in the blood work, that might be it and say come back in a year.

It sounds like your Prostate is okay at present. If you were concerned that these nodes represented Prostate cancer that would mean it had spread and it usually does not go to those nodes first and if had, it would be unlikely the MPmri would have missed anything on the prostate. I don’t know whether I would even worry about getting a second opinion on the MRI. If you were still concerned about your Prostate for cancer and If you wanted a little more assurance you could ask your Urologist for an EXO DX urine marker test, but he does not seemed concern.

alexrtk

Thank you for your response. Maybe I'm a little bit overreacted 😊

Clevelandguy

Hi,

According to your MRI you have an enlarged Prostate(hyperplasia) which could account for your higher than normal PSA number. Did they mention the size of your Prostate in the MRI notes? A normal Prostate is somewhere around 25ml. Like the other folks have said a second opinion might not be a bad idea.

Dave 3+4

alexrtk

My prostate volume is 56 cc

alexrtk

And PSAD 0.0875