Help with mri report

wworker

Hi,

I was diagnosed in January with Gleason 3+3 (no MRI prior to biopsy).

PSA was 4.5 last week.

I had an MRI today and just received the results below.

Multiple prostate lesions as above.

PI-Rads v2.1 score: Pirads 5 - Very high (clinically significant cancer is highly likely to be present)

Narrative

MRI of prostate with and without contrast, without Endorectal coil:

Finding;

Peripheral zone:

1.5 cm lesion in the right posterior medial peripheral zone at the prostate apex. This demonstrates marked ADC hypointensity and DWI hyperintensity. No focal abnormal postcontrast enhancement kinetics appreciated. PI-Rads 5.

1.0 cm lesion in the left posterior medial peripheral zone at eh prostate mid gland to apex. This demonstrates mild ADC hypointensity and DWI hyperintensity. No abnormal postcontrast enhancement kinetics. PI-Rads 3.

Transitional zone:

There are also bilateral mid to apical transition zone lesions demonstrating heterogeneous T2 hypointensity with obscured margins. PI-Rads 3.

Volume: The prostate gland measures 4.7 x 3.5 x 3.5 cm for a volume of 30 cc.

Other: Seminal vesicles show normal bright signal on T2 weighted images. No extracapsular involvement identified. No adenopathy o r osseous lesions. Diffuse bladder wall thickening is present.

PSA density: 0.25

Due to a vacation, my follow up appointment isn't until mid-May, so any help sorting through this would be appreciated.

My urologist was recommending active surveillance at my February appointment, with another biopsy following the MRI.

I'm wondering if this changes anything?

Clevelandguy

Hi,

With AS you will have biopsies every so often to monitor your Gleason score, the MRIs should tract cancer location and tumor size. Many people with 3+3 go on AS for many years, its up to you and your doctor team to delay treatment with AS or deal with the issue now ie; surgery or radiation. Did the doctors give you any idea of the volume of the tumors vs Prostate size, that what I would ask on your next appointment. If you have small volume you could stay on AS for some time.

Dave 3+4

Old Salt

The Pirads 5 lesion at the apex needs to examined further, or was this one of the Gleason 3 ones identified earlier?

Has your PSA been going upward (lately)?

I don't think that waiting until mid-May for further evaluation presents a problem.

swl1956

I believe an MRI should have been done prior to a biopsy. What kind of biopsy did you have?

lighterwood67

Really, I don't know that much about Active Surveillance. I would guess that you are going to have the same questions after an MRI or biopsy which is what you should be doing. Asking questions and staying on top of the medical data provided. Good luck on your journey.

wworker

Thanks for the replies.

I don't have any additional information regarding the volume of the tumors.

The previous biopsy report indicated Gleason 6 in the "right medial apex"

My PSA had been trending up from 3.72 in 10/22, 4.58 in 10/23, 5.24 in 12/23 and 7.5 in 2/24. Last week it was 4.59

I guess my concerns were the "Pirads 5 - Very high (clinically significant cancer is highly likely to be present)" comments.

Is Gleason 6 "clinically significant cancer"?

VascodaGama

Hi Wworker,

Your initial thread (Feb) has the important information about your case. The MRI results you describe in this thread doesn't add anymore relevant data to help you in making a decision.

In any case, the term "clinically significant cancer" used in MRI reports signifies that the lesion has high probabilities of being cancerous.

Such results you have it already in hand as reported by the pathologist on your biopsy. 6 positive cores out of 12 cores template.

These were identified as Gleason rate 3 (low risk in aggressiveness) but your case is considered voluminous (right and left lobes, at the base, mid and apex) which may not be proper for an Active Surveillance approach.

They have identified perineural invasion (cancer cells existing alongside the nerves bundle) that can signify existing extraprostatic extensions (a none contained case). These tiny spots usually are not detected in MRI or CT exams.

The good info from the report above is about the negative invasion in the Seminal vesicles.

I think you should get second opinions on treatments instead of following AS. Surely you have time to gather more information on your status.

Best wishes and luck in your journey.

VGama

wworker

Hi VGama, thanks a lot for the input.

Without experience interpreting mri reports, it's hard knowing what is, or isn't, new information and I'm not comfortable with the uncertainty.

I will look into a second opinion as suggested.