Just had MRI NorthWestern

miabarry

Hello:

First post. July 2nd during physical GP detected abnormality during DRE. I have been taking finasteride for many years. PSA has always been low and stable (understand that it would be higher but for the rx). Free psa% 18.1. PHI 21+. MRI results below. Any thoughts would be appreciated. Biopsy scheduled for end October with Ashley Ross.

PROCEDURE: MRI PROSTATE W WO CONTRAST HISTORY: Elevated PSA. Most recent PSA 1.16 ng/mL on 7/5/2024. PHI: 21.16

TECHNIQUE: Multi-parametric 3.0 Tesla MRI was performed using a torso phased-array coil, including multiplanar T2-weighted images, axial T1-weighted images, axial diffusion-weighted images, and volumetric dynamic post-contrast images of the prostate. Axial in-and-opposed-phase gradient-echo T1-weighted images and pre- and post-contrast fat-suppressed gradient-echo T1-weighted images of the entire pelvis were also obtained using the "Prostate with Contrast" protocol.COMPARISON: None.FINDINGS:Prostate size: 3.5 [CC] x 5.4 [AP] x 4.3 [TV] cm for an overall volume of 43 cc. PSA density: 0.03Lesion 1 in the peripheral zonePI-RADS assessment category: 4, High probabilityAppearance on T2-weighted images: 4, circumscribed, homogeneous moderate hypointense focus/mass confined to prostate and <1.5 cm in greatest dimensionAppearance on diffusion-weighted images: 4, focal markedly hypointense on ADC and markedly hyperintense on high b-value DWI; <1.5 cm in greatest dimensionAppearance on dynamic post-contrast images: Positive - focal enhancement directly corresponding to the suspicious finding with early or contemporaneous enhancement to normal prostateSize: 1.2 x 0.8 cm, series 14 image 11 (ADC map)Side: Predominantly left, but crosses midline.Zone: PeripheralLevel of prostate: ApexLocation within transverse plane: PosteromedialExtraprostatic extension: Abuts the prostatic capsuleAdditional peripheral zone findings: Linear or wedge-areas of decreased signal on T2-weighted imaging with associated diffuse increased perfusion, suggestive of prostatitis. Additional transition zone findings: Enlarged and heterogeneous with circumscribed nodules consistent with benign prostatic hyperplasia.Extraprostatic extension: None.Seminal vesicle invasion: None.Lymph nodes: No pelvic lymphadenopathy.Osseous structures: No aggressive osseous lesion.Additional findings: The urinary bladder is unremarkable. There is diverticulosis of the visualized colon, without evidence of diverticulitis.IMPRESSION:* 1.2 x 0.8 cm left posteromedial apex peripheral zone lesion that crosses midline towards the right, corresponding to an assessment category of PIRADS 4 - High (clinically significant cancer is likely to be present).* No pelvic lymphadenopathy.The prostate gland was segmented and the suspicious lesion(s) were annotated on the DynaCAD system for UroNav guidance.

Wheel

Numbers don’t seem really bad even with a Pirads 4 lesion which in many cases can still be a benign lesion.. I know you put your low PSA off to your prescription but the conversion is x2 to 2.3 to give you a corresponding PSA without being on the medication which still puts your PSA pretty low in the mid 2’s. I would ask for a ExDxo Urine marker test. It is non invasive and is used to see if your cancer is low grade and can delay biopsy for awhile, and continue monitoring PSA. It is sent off to a lab and results are back in 48 hours. Google the test, but your Doctor needs to put the order in with the company. You appear to have some history of prostatitis which can scar the prostate and possibly your BPH which might have caused the abnormality feeling in the DRE. Free PSA is talked about under 20 to 25% for a PSA of 3 and since your number is 18% might not be too bad since there is some data that the lower your PSA is the less accurate Free PSA is in determination of cancer. Clearly a MRI fusion directed biopsy of the lesion will clear that up and hopefully its nothing and in the minimum you have a baseline MRI. Although at this point with the biopsy already scheduled soon, depending on results get the genomic Decipher test done on the tissue again to see if your cancer then is low, intermediate or advanced.

miabarry

thank you, Wheel

Old Salt

Good advice from Wheel.

I hope that you can find a specialist that can do an MRI fusion biopsy.

lighterwood67

Good that you have a biopsy scheduled for the end of October. To the best of my knowledge the only definitive test for prostate cancer is a biopsy. The fact that you have had an MRI, as said above, will also allow suspicious areas to be targeted when the biopsy is performed. Good luck on your journey.