MRI PI-RADS 3

Ken71
Ken71 Member Posts: 9 Member

Rapidly rising PSA (1.9 to 7.6 in 6 months - but might be due to just having Covid. Urologist wants retest in a month). MRI shows 8 mm lesion (mild decreased T2 signal, DWI=3, but without rapid contrast wash). Is this probably cancer? Should I get a biopsy? (I also have BPH).

Comments

  • Marlon
    Marlon Member Posts: 127 Member

    Ken71, did your doctor do a digital exam? Only a biopsy will tell if it's cancer. Normal procedure is to do the MRI first in order to show them where to take biopsy samples. If they used the word fusion in the MRI process, thats likely what they are planning to do. BPH itself will cause a higher PSA.

  • Ken71
    Ken71 Member Posts: 9 Member

    yes he did a DRE. It was negative

  • Wheel
    Wheel Member Posts: 161 Member

    Ken,

    I agree additional PSA, although that is a big jump. Having BPH can result in higher PSA, but such a jump needs further investigation. Covid also can increase it, but again its a large jump. It’s always possible the combined covid and BPH contributed, but your Urologist is right to say lets retest as the first step. The lesion could be benign, and also if you have had any prostatitis, that can leave scaring the MRI can pick up, but describing a specific lesion also needs further monitoring. It’s good you have a base line MRI, as if they do some initial AS watching your PSA over the next few months and say in six months they do another MRI they can compare. If I were you and your PSA is still up significantly from its regular number I would push for the biopsy, although at that point your Urologist may be in agreement. If your PSA lowers but not by a significant amount don’t accept that if your PSA lowers that you don’t have cancer. In the meantime ask your Doctor to include your “Free PSA” level in your next PSA test and Also ask about your Doctor ordering the urine test known as ExoDx prostate test. It measures markers in your urine that measures 3 genomic markers showing if you have cancer cells and how slow or aggressive they are. This test is used sometimes to rule in or out a biopsy by the score. It’s a very non invasive test that the Urologist orders and you do at home and ship off. Once I got that result I pushed for another MRI and then the biopsy as my PSA was going up, down, down, up and down over a year as my Doctor kept watching it. Fortunately most Prostate cancer’s are slower growing and even if advanced if caught early through continuous surveillance your treatments are all open. If your PSA only just went up in the past six months you can monitor it but frequently get your PSA tested now and see about the ExoDx test which could get your Doctor to act quicker if it shows something. He may want to do a biopsy now with the lesion, but having the urine test results in a week can really move things along. That test you don’t need to wait on and can just be done now and is not tied to your PSA number, but if it shows something it can be pretty accurate that there is cancer but cannot Gleason grade it, only a biopsy. Sometimes with the results a Doctor will be more proactive in ordering the biopsy then just watching a PSA go up and down. One Doctor I had said you can’t have cancer because your PSA would not drop only keep going up. Boy was he wrong. These things can be done prior to a biopsy pretty readily. If you do get the biopsy make sure its a MRI fusion guided to target the lesion.

  • Ken71
    Ken71 Member Posts: 9 Member

    Thanks, Wheel. I'll do more testing.

    My PSA has stayed the same (1.9-2.1) for many years (I'm 71), then jumped in 6 months to 7.6, maybe due to having Covid/BPH. The lesion seen on MRI is 8 mm. Is it typical that a cancer can grow that fast? Or could it be extremely aggressive? (I assume that having a low and unchanging PSA given my age means there was nothing wrong before). Does prostatitis always make you feel bad (I feel fine)? Thanks.

  • Wheel
    Wheel Member Posts: 161 Member

    Ken,

    I just turned 71. Two years ago My PSA had stayed 1.9 for years and years and then jumped not as dramatically as yours but to 3.4. Had initial MRI that did not show anything but at time believed to be scarring from prostatitis. Then my PSA bounced around up and down back as low as 2.7 and up at its highest 4. My PSA was followed for 12 months, but then when the ExoDx test came showing an aggressive number, my Doctor then did another MRI and this one showed a definite lesion, PIRADs 4 . That led to biopsy, although lesion came back benign , other grid random cores showed cancer, one a Gleason 8. I just had surgery 3 months ago. Even with what my cancer turned out aggressive, even with the monitoring, even from biopsy to treatment consultation’s to surgery additional 6 months. So if yours just popped up, you are on it as I was. I followed my PSA and kept questioning my Doctor. Get your free psa checked as my low free psa number also showed likely cancer as well as the ExoDx

  • Clevelandguy
    Clevelandguy Member Posts: 1,205 Member

    Hi,

    The discovery of the lesion by the MRI needs to be investigated via a biopsy as stated above by Marion and Wheel. Use the MRI data to guide your Urologist when doing the sampling. Your PSA is probably elevated to some extent by your BPH.

    Dave 3+4

  • Josephg
    Josephg Member Posts: 460 Member

    I recommend getting another PSA test in a month, and then re-evaluate. If the PSA is still fairly high, then I recommend getting an MRI, followed by a biopsy.

    I had an elevated PSA (3.6 - 5.3) for 5 years with 'negative' digital exam results each year from my PCP. After my PSA reached 5.3, he recommended that I see a Urologist, and the Urologist ordered a biopsy. The biopsy came back as Gleason 4+3, involving most of the prostate (on the backside, where a digital exam cannot reach), with the likelihood that the PCa had already escaped the prostate (later confirmed).

    Lessons Learned: If something seems like it is not right, investigate further sooner than later. Engage a Knowledgeable Specialist when engaging in further investigation.

  • Ken71
    Ken71 Member Posts: 9 Member

    I just had another blood test (1 week after the last one). My PSA went back down to 2.8 (almost normal), from 7.6. I guess because of COVID/BPH. But the MRI showed an 8mm lesion Pirads 3. I meet the doctor next week. Will I still need a biopsy?

  • Old Salt
    Old Salt Member Posts: 1,530 Member

    MRIs are only suggestive. If you want total peace of mind, you should go for the biopsy. Personally, I would just follow up with PSA tests and, if necessary, another MRI if the PSA goes up significantly.

  • Wheel
    Wheel Member Posts: 161 Member

    Ken,

    I might follow up with another PSA in 30 days. Waiting 30 days and retesting still beats a biopsy. Your latest test of 2.8 is still not a return to your historical 1.9, it is still a percentage rise of almost 50 %. If your PSA does falls further , the lesion could more likely be benign, but as Old Salt said only a biopsy would tell you that if it was for your peace of mind. However you might still get peace of mind in 30 days if your PSA did fall again. Now, If in 30 days your PSA remains at the 2.8 or goes up then I would consider the biopsy. IN the meantime if you are going to retest in 30 days ask your Doctor about the ExoDx test I mentioned earlier. You could also get peace of mind from that test without going the biopsy route for the time being. If you have a raised number there, you will feel more comfortable getting the biopsy sooner than later without continuing for more PSA tests. If you have a low ExoDx number and your PSA is not rising anymore, maybe then you continue closely monitoring your PSA and if it starts rising again, then at some point another MRI and biopsy. Another MRI from your baseline MRI will also reveal if the lesion is growing and at what pace. Things to discuss with your Doctor.

  • centralPA
    centralPA Member Posts: 341 Member

    Twice now I've had two separate PSA tests within a week of each other. One from the urologist and another from the PCP. I didn't tell them I was getting two, because I wanted to see how close they came out. Bottom line is there is a good bit of noise in the signal. Maybe 20% difference each time.

    Good call on the retest. That 7.6 sounded like a bad test.

    I'd ask for one more in a week, to see if you are trending down from some weird spike.