Confused after MRI

REB72

I know I am in the early stages of possible PCA diagnosis as my biopsy is scheduled on 4/23. But I am really blindsided by this. I am 52 years old. I have absolutely no symptoms other then noticing some possible ED over the past year. My doctor ordered PSA test in on 2/20 and it came back as 14.97 and another test was conducted on 3/4 that came back as 16.86. I was seriously doubting these numbers being serious but I did follow up with referral to urologist. Dr said he felt a large nodule when he conducted DRE. MRI was scheduled and two lesions were found. One being pi rads 5 and other pi rads 4. I have no family history of PCA that I know of. I will have to admit I am scared right now. The biopsy is going to be a fusion biopsy. I believe it is rectal. There is one tidbit of other information that I am not sure is relevant. As a young teen I had a testicular issue that caused me to lose right testicle. We are not sure what happened. I woke up in severe pain and vomiting one morning. Surgery to pelvis area scheduled next day and come to find out my testicle was dead. Possible torsion or twisting of cord. I eventually got a silicone implant in 1989. I was 17 at tglhe time. Never have had any problems with it and it is still there. Just wondering if this could be related to what might be going on with prostate. Or could there be scaring caused by Surgery to pelvis causing irregular findings on MRI or even silicone leaking from implant causing cancer. Below is a snip of MRI findings. Prostate is 27 ml and density is .62. I am just not sure if I need to be worried. I do have a young teenage daughter that needs me. We are also not doing the greatest financially to take in this burden

Prostate Lesion 1:
Size: 2.1 x 1.2 x 3.1 cm
Location: Right peripheral zone (series 7, image 12; series 10, image 12; series 11, image 18).
The lesion superiorly abuts the base of the right seminal vesicle without definite invasion.
Margin/Extraprostatic Extension: Probable extraprostatic extension based on the length along
the peripheral zone greater than 1.5 cm.
DWI: 5, Focal markedly hypointense on ADC and markedly hyperintense on high b-value DWI;

1.5 cm in greatest dimension or definite extraprostatic extension/invasive behavior.

T2w: 5, Circumscribed,homogenous moderate hypointense focus/mass, >= 1.5 cm or with

definite extraprostatic extension/invasive behavior

DCE: Yes

PI-RADS: 5

IMPRESSION:

1. PI-RADS 5 prostate lesion involving the majority of the right peripheral zone, most prominent

in the right apex. Probable extraprostatic extension is present on the right at the location of the

right neurovascular bundle without definite involvement. The lesion comes within close

approximation of the base of the right seminal vesicle without definite involvement.

2. PI-RADS 4 subcentimeter lesion in the left peripheral zone without extraprostatic extension.

3. Ill-defined decreased T2 signal and enhancement throughout the remaining peripheral zone

of the, which could represent infiltrating malignancy versus prostatitis.

Clevelandguy

Hi,

I doubt if the testicular implant has anything to do with your high PSA. Your high PSA and your rectal exam would indicate something is going on cancer wise. The biopsy using the MRI data will determine if you do have cancer and the aggressiveness of it via your gleason score. Good luck…..

Dave 3+4

centralPA

@REB72 your MRI definitely demands attention. I don’t think your testicular implant has anything to do with your situation.

When is your biopsy?

REB72

Thanks for your help Cleveland guy and central ipa. I wasn't sure about that implant. I did mention that to my urologist and he also indicated it was unrelated. My biopsy is 4/23.

lesjanes

https://csn.cancer.org/discussion/327897/confused-after-mri

Very similar to what my MRI report looked like 2 "areas" one RAD 5 the other RAD 3. The major differences between us is that my Prostate Density was .17 and my PSA was 5.4.

Regarding the biospy, that will really tell the tale based on the Gleason score. I had two biopsies, one awake one one knocked out (fusion I guess) . I personally did not have any issues with the biospies as far as discomfort and recovery. Light bleeding for 1 day urinating, a slightly uncomforable in the lower abdomin area, but no pain meds required. Blood in semen takes several weeks to clear out.

REB72

Lesjanes. Thanks. I am not too worried about the actual biopsy. I am worried about tge results. This waiting game is driving me insane. I was not expecting these high PSA #'s. I had tests for this before looking at my chart through my doctor. I didn't go to the doctor for several years as he retired. But in 2020 it was just over 3. From 3 to 16 looks like a considerable jump in 4 years. With absolutely no symptoms. I guess I can hope for good biopsy results. Not something I was expecting as nobody I know has gone through this and do not know what to expect.

centralPA

Nothing happens fast, it seems, with PCa. Sorry for your wait, and then you have to wait for pathology after the biopsy.

While you wait, decide if you want to hear the results from the doctor or see them for yourself as soon as done. I was and am a "see them for myself" person, so I monitored my patient portal closely after my biopsy, and saw the pathology report directly.

JasonB176

I definitely understand the anxiety. My story can be found not too far down the page.

I also had a PI-RADS 5 lesion on my MRI but my biopsy came back with 4 cores positives, 3 of which were only Gleason 3 + 3. The fourth one was 3 + 4 but only 5% of the 4. I got conflicting recommendations from two urologists. One said I should have surgery soon but the other one gave a strong recommendation to only do active surveillance for now given the low amount of Gleason 4.

I relate my story as it relates to your case in that having a PI-RADS 5 MRI does not necessarily mean immediate treatment is needed. Hopefully your biopsy comes back without significant cancer.

swl1956

Hi REB72

I too can empathize with your anxiousness. I was diagnosed last November with 4+3 and won't be treated until the end of May. It's been a roller coaster of emotions and stressful to select a treatment and who is the best to do it. Try not to panic. (easier said than done) Pca is usually very slow progressing. You likely have more time than you think to determine a treatment. The biopsy will narrow down the options you'll have. Keep in mind Pca is a treatable disease with high success rates. Albeit still an infliction we wish we didn't have to deal with. 😒

https://www.google.com/search?q=pcri+dr+mark+scholz+how+long+can+you+wait#fpstate=ive&vld=cid:a2542947,vid:aotF2SPzCmU,st:0

Hang in there! ☺️

Old Salt

All good comments!

Patience is a virtue…