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My MRI Results Are In

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

I jest received my MRI results. Can someone PLEASE help me understand? What's good and bad about what you see here?

 

"FINDINGS":
"please note diffusion imaging is limited at the mid glad and apex due to artifact from adjacent bowel gas"
THE PROSTATE GLAND
overall sizeprostate dimensions = 4.7 X 3.5 X 4.3cm {maximum transverse, anteroposterior, and cranioucaudal dimensions, respectively}

PERIPHERAL ZONE:
no T1 hyper-intensity in the peripheral zone.
peripheral zone focal abnormalities

lesion 1
size: .9 X .8cm
location: left apex at 3:00 o'clock

REPORT
multiparametric MRI features:
T2-WIs: dark {series 4 image 11}
DWI: bright {series 6 image 62}
ADC map: dark {series 7 image 10}
DCE-MRI: negative
pi-rads:4

lesion 2
size: .9 X .6cm
location: right mid gland at 10:00 oclock
multiparametric MRI features
T2-WIs: dark {series 4 image 15}
DWI mildly bright {series 6 image 66}
ADC map: mildy dark {series 7 image 14}
DCE-MRI: negative
pi-rads: 3

lesion: 3
size: 2.5 X 1.1cm
location: diffuse left mid gland
multiparametric MRI features:
T2-WIs: dark {series 4 image 17}
DWI: mildly bright {series 6 image 68}
ADC map: mildly dark {series 7 image 16}
DCE-MRI: negative
pi-rads:3

central gland:
no changes of BPH
no central gland abnormalities

*extraprostatic tumor extension: none
*neurovascular bundles: normal
*seminal vesicles: normal
*urinary bladder: normal
*pelvic lymphadenopathy: none
*enhancing pelvic bone lesions: none

other incidental findings:
mildly prominent bilateral inguinal lymph nodes are nonspecific and may be reactive.

IMPRESSION:
1. 3 peripheral zone focal abnormalities, one of which has multiparametric MRI findings with a pi-rad 4 lesion and two of which have 
multiparametric MRI findings consistent with pi-rads 3 lesions.

2. no evidence of extraprostatic disease, pelvic lymphadenopathy, or enhancing pelvic bone lesions.

Old Salt
Posts: 720
Joined: Aug 2014

since there have been no responses up to this point.

First of all, prostate MRIs don't prove a thing. Just suggestions as to what to do next. False negatives are common.

My take is that the results in the report are not alarming as such. Just re-read the IMPRESSION (summary).

With respect to the PI-RADS scores, five is the worst and you don't have any of those. One PI-RADS 4 lesion and two PI-RADS 3 lesions. A biopsy of those areas would be informative because only a biopsy can prove that a lesion is cancerous. Unfortunately, (twelve needle) biopsies may miss those from time to time.

Please do not hesitate to ask further questions.

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

thank you, old salt, for being kind enough to take the time to answer my concerns. 

Clevelandguy
Posts: 470
Joined: Jun 2015

Hi,

I would assume the next step would be a biopsy of the "suspicious" areas searching for cancer.  In my opinion the MRI is a good tool to find areas to biopsy rather than just shooting in the dark.  Let's hope for no cancer found...............

Dave 3+4

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

thank you for responding. a targeted biopsy is what i'm shooting for. i just hope it's not the big C. or if it is, it's not aggressive.  

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

I agree with the above comments. The biopsy results are missing to judge your status. If positive then you will get a clinical stage from where a therapy is drawn.

I do not recall your history (can't find your previous posts) but I presume you have received great opinions from survivors in this forum. Let's hope for a negative to cancer result.

Best wishes,

VG

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

thank you, VG. here is my med history

========================

12.18.2013 | Turned 40 yrs. old
07.09.2014 | Annual physical 
07.11.2014 | P.S.A. 5.5 Referred to Urologist
07.29.2014 | Urologist performed DRE found nothing.
08.19.2014 | Biopsy performed
08.25.2014 | Diagnosed with Asymptomatic Inflammatory Prostatitis & BPH
===============================================
07.29.2015 | PSA is 5.9
===============================================
01.14.2016 | PSA is 7.6
03.09.2016 | PSA is 6.2][ Apifiny Blood Exam results 41 {Low risk of having PC}
07.08.2016 | PSA is 6.92
10.17.2016 | PSA is 6.94
===============================================
04.14.2017 | PSA is 7.2 ][ Normal DRE. MRI is recommended
05.09.2017 | 3T MRI Came back normal. Keep six month appointment.
===============================================
11.27.2018 | PSA 07.74
06.01.2018 | PSA 10.84][-Taking Cipro for two weeks. Re-test PSA
07.10.2018 | PSA 11.9
08.22.2018 | 3T MRI

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Sw,

Thanks for sharing the details. I am not sure but I recall reading that you have/had PCa cases in your family (can you provid me the link). This MRI has found suspicious areas that you should consider investigating further in your next biopsy. The high PSA requests that.

If diagnosed positive, you need to know the details involved in each treatment before choosing. One needs to treat but young patients should weigh the benefits against the loss of quality living due to treatment side effects.

Best wishes and luck.

VG

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

hi vg,

my apologies, if i lead you to believe there was prostate cancer in my family. no one i know of in my family ever been diagnosed with or lost their battle from it. but, i am grateful to you for being kind eenough to even respond and try to offer some words of encouragement.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3323
Joined: May 2012

SW,

Your doctor is a dunderhead -- my layman's opinion.

You had PSA results between 11-27-17 (incorrectly written as 11-27-18, which aint here yet) and 7-10-18  with a doubling rate (vector) of around nine months ! Ouch !  And six weeks later, the doc orders an MRI, instead of a biopsy (MRI for PCa is close to worthless and will see nothing except in cases of advanced metastasis).

If he thought it possible that you had PCa bad enough for an MRI to detect, why did he not also order the one truly necessary diagnostic tool, a biopsy ?  Yes, you had a biopsy in 2016, negative. But a lot can (and did) change since then (specifically, your PSAs), and PCa biopsies are notorious for false negatives. DREs test only the rear of the gland, not the front half, and therefore a negative DRE is of little value, although a postive DRE is very significant.

11-27-17:   7.74

7-10-18:     11.9   This indicates a vector of well under one year (another PSA result from June 2018 fits perfectly on this linear increase).

In addition, your PSA numbers, even if they were static (looking just at one number, with no vectoring) would still cause a competent urologist to order an immediate new biopsy.   But your doctor takes a PSA result of almost 12, and after a Cipro regimen, six weeks later orders an MRI.  Thousands of men in just the US annually are diagnosed annually with PCa who never had PSA results above 5 in their life. I had stage II with a lifetime high of 4.3.  My cousin was diagnosed last year with a 4.1.

My own family doctor had been testing my PSA annually, and over two years it went up about 1.0 each time. When it got to 4.3, I asked what he thought. He said that the PSA was meaningless, that PSAs are overused, and to forget about it. He also mentioned that insurance carriers agree with his line of thought. (Note: Insurance companies mostly agree with things that cost them no money.)  I called a urologist the same day and went n the next week for a review. She recommended an immediate biopsy the next week, which came back positive. staged at I.  In under a month I had the gland removed, and it was actually a significant Stage II at that time.  Live and learn.  I err on the side of caution. Which side is it safest to err on ?

The most overt, educated guess regarding your results is that you have  PCa at work, possibly somewhat aggressive. NOT CONFIRMED, but the best read of the limited data.  Print this and have him read it,if you wish.  A smarter move would be to go to a different doctor for a second opinion . Let HIM read it...

Disclaimer:  Like all of the writers here, I have no (ZERO) medical training at ANY level. Have him explain why I am wrong. I'm interested also.

max

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

1. "You had PSA results between 11-27-17 (incorrectly written as 11-27-18, which aint here yet) and 7-10-18  with a doubling rate (vector) of around nine months ! Ouch !  And six weeks later, the doc orders an MRI, instead of a biopsy (MRI for PCa is close to worthless and will see nothing except in cases of advanced metastasis)."

Ans: you're right. that was a typo on my part. and 15.48 is doubling and i seriously doubt you saw a 14/15 PSA.

2. "Yes, you had a biopsy in 2016, negative. But a lot can (and did) change since then (specifically, your PSAs)"

Ans: well, actually i had a TRUS biopsy in 2014, from a different urologist. if that was another typo, then my apologies to you.

3. "11-27-17:   7.74

7-10-18:     11.9   This indicates a vector of well under one year (another PSA result from June 2018 fits perfectly on this linear increase)"

Ans: Y wouldn't you consider this as just a spike, with possibly inflammation, or BPH?

4. "Thousands of men in just the US annually are diagnosed annually with PCa who never had PSA results above 5 in their life. I had stage II with a lifetime high of 4.3.  My cousin was diagnosed last year with a 4.1." AND "The most overt, educated guess regarding your results is that you have  PCa at work, possibly somewhat aggressive."

Ans: C, when you make these two statements you throw me off. first it sounds like i may NOT be diagnosed with PC, then in your "most overt educated guess" you sound like may i will be diagnosed with a possible aggressive form of PC. my question to you is, which is it?

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3323
Joined: May 2012

Sorry to be late responding, SW. I have not been to the Prostate Booard for a few days.

As regards whether or not your PSa of 7-10-18 was "most likely a spike ?", I would answer "No, most likely NOT a spike."  This is due to the result fitting so well into your overall history.  And BPH/BEP (different names for the same thing) seldom send PSA levels that high.  I'm sure some guys here have experienced such, but it is not common. 

I had significant BPH for about 5 years before a PCa diaagnosis, and chronic prostatitus off-and-on for 30 years (yes, 30 years) and never had a PSA result over 4.3.  Prostatitus bad enough to have blood in the urine at times....and this passing blood occured mostly decades before I got PCa.   My pathology report of the removed gland, besides the Stage II cancer, reported, "significant inflammatory tissue from chronic prostatitus."  But again, never a PSA of over 4.3.  [[ Fact not commonly known:  MOST prostatitus is both non-bacterial and non-viral; it is caused by inflammation, not infection. Hence, MOST cases of prostatitus is unaffected by antibiotic treatmetns. ]]

Regarding your last question, as to "which is it?"  No layman here, and not even any doctor, can say that for certain. Only a biopsy can answer that question.

max

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

i appreciate your response and i do understand that we have lives outside of this forum. so, please don't worry about how long it takes you to reach out to me. i'm just glad you cared enough to respond. not trying to sound as if i'm denial, but i've read quite a few stories where one guy had a PSA as high as 59, had mulitple biopsies and no cancer. one guy had a 21 PSA, MRI done with biopsy, no PCa. another guy had a PI-RADS 5 on his MRI lesions, with a negative biopsy. now, will that be same case for me? i hope so, but i won't sleep on it. my argument is basically [respectfully] every situation is different, even if U are correct about me. 

Old Salt
Posts: 720
Joined: Aug 2014

Nobody can diagnose prostate cancer based on PSA and MRI results.

PS: Several of us are in agreement that the next order of business is to get a biopsy. Please re-read the earlier comments.

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

i have read the earlier comments. i'm no longer questioning the next step, but i did have a few questions for the person who posted just before you.

GeorgeG
Posts: 127
Joined: May 2017

There are some newer MRI capabilities that have much better diagnostic value than in the days of past and can give a pretty good indication of the presence of cancer. Some believe that in the future this may develop into a full diagnostic tool but not today for sure and standard MRI technology is essentially useless as a diagnostic tool as staed by Max and others. . The problem is twofold: you will not get treated by any mainstream center or doctor without the biopsy to confirm and without the biopsy you have no initial Gleason score which is important to develop the best treatment plan even if you know 100% that it is cancer from a scan, especially if radiation is chosen and the prostate is not coming out.

Bottom line as stated above, once there is a high likelyhood of cancer/risk through PSA, family history, scans, etc - the biopsy is next If you had a newer scan - T3, ER coil, contrast then as staed you have a very good guide for the biopsy locations to avoid false negatives and get a good assesment as to your status.

While not conclusive, you MRI read suggests no cancer outside the prostate and no SV or lymph node involvement. What this suggests is no locally advanced disease and remember that PC has a 97% survival rate. 85% of men 85 years old have prostate cancer and almost all of them die of something else. Try to relax until you know more.

Best of luck

George

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

i plan to have an MRI in-bore guided biopsy. i'm going to call monday, to make sure my insurande will pay.

GeorgeG
Posts: 127
Joined: May 2017

The best technology available today is a 3T (the magnet), endo rectal coil (the receiver) image with contrast. Then they do a "Fusion  biopsy", merging the MRI view with the real time ultrasound guided biopsy process to increase the likelyhood of sampling all problem areas and properly assesing your situation.

Good luck,

 

George

 

Sw1218's picture
Sw1218
Posts: 55
Joined: Jan 2016

based off of my research, the MRI targeted biopsy would be the better choice. Y in your opinion do you believe otherwise?

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