hi all. Very sad at the moment and terrified. I recently went for an MRI for gastritis, and the report found some hypointensity signal at the peripheral of my prostate.
went to a urologist immediately, and we did a rectal exam. Doctor said he couldn’t feel any lumps and prostate wasn’t enlarged ( also confirmed by MRI). Did. PSA text, it came back at 0.33. I am 42 years old. The doctor however couldn’t explain away the MRI signal so I decided to get an MP MRI done. Just got the results back, and was given a PI RADS score of 2.
im really worried ( I know score of 2 means cancer is unlikely) and even my Uro said he thinks less then 10% chance of cancer. But my other tests seem to come out normal, DRE , PSA but then wouldn’t I get a PI RADS of 1?
anyways decided to go get a prostate biopsy done against the recommendation of my doctor, he said if it was him, he wouldn’t do something invasive right now. But I’m so scared and worried, we can’t come up with any other explanation for my MRI.
What do you all think?
Think your urologist is correct. I would just stay on Active Surveillance as I am on although I have confirmed cancer. Regular PSA and yearly MRI and only have biopsy if PSA much higher or MRI indicates some suspicious area
How were you confirmed with cancer? Was it through a biopsy?
I think that your Dr is right just have annual PSA blood tests to see if anything changes and try to relax until there is something to fret about.
Good luck Richard. Who had prostrate cancer four years ago.
Yes but my PSA suddenly increased to 8.75 and the MRI showed two suspicious areas. My urologist recommended a template biopsy
The problem is that a biopsy can find cancer but because the needles can miss where there might be cancer cells, it cannot eliminate the possibility of cancer being present. I had a 12 needle biopsy and only one suspicious cell was found. Several years later I had a 'saturation' biopsy of 36 samples and a couple of cells were found. I therefore have a diagnosis of Gleason 6 (3+3) adenocarcinoma of prostate. My PI-RAD is 3. I remain on active surveillance. No treatment for the cancer.
Relax - you don't need a biopsy!
There is a blood test you should have completed called the 4Kscore. This can completed prior to biopsy, or after a negative biospy, and can predict the likelihood of cancer spreading to other parts of your body in next twenty years.
Be great if you had more PSA tests done for a few earlier years. Then you could see if there is any steady but relentless doubling progression. It is the rise in PSA over say a 12 month period that gives the warning signal. I would be ecstatic with your 0.33 PSA. Mine hovers between 2.2 and 2.5 over the last 15 years.
The PIRAD of 2 is very good. If you had the MRI with a good MRI machine and good radiologist, then you probably have no issues. That was the same score I achieved. Radiologist said, unusual to get a PIRAD of 1 in an adult, as the prostate tissue becomes more dense as we age, and a score of 2 is good.
Do not go down the very invasive biopsy route unless absolutely warranted..eg, the MRI can see and measure the PCa lesions, your PSA is rising and you want to assess how aggressive the PCa is.
I would wait three months and get another PSA done and go from there.
For me, it turned out I'd previously had a massive UTI attack my prostate a few weeks before my annual blood tests, which spiked the PSA to 15(in 3 months) from my average of 15 year average of 2.4. DRE was normal. All the various blood tests(PSA Free and PHI) said high chance of PCa. The MRI said PIRAD 2...stop worrying. My PSA is still falling back, indicating the prostate can take many months to recover.
The only way to know whether or not you have prostate cancer is by biospy of the tissue. Remember, good chance you have nothing and if you do it sounds like low grade. There are 29 different treatment options and just keep up with your checkups and get a blood test completed in genomic testing. Cover all angles and always get second opinion.
Good luck and god bless.
Thanks for your reply. I was happy with my 0.33 PSA score, but also realize that it is low because of my age (42). From what I understand, it increases the older you get, so I guess its relative.
The comment about PIRAD of 1 being uncommon in adults is reassuring - that was whats really worrying, I assumed withm y PSA, age, normal DRE, and no family history of cancer, that the PIRAD would have been 1, and it bothered me that the two Uros I saw didn't really have an adequate explanation of what they saw on my general MRI.
As far as the biopsy goes, I figured the risk was low (as explained to me) with some minor discomfort such as bleeding for a few days potentially, that there was no harm getting it done. I tend to worry a lot, and peace of mind is worth a lot to me. I did email my Uro and confirmed that it was going to be a transrectal ultrasound guided biopsy. From what I have read here, that is not the BEST type of biopsy to get, but is it good enough for now?
May I ask how old you are? Reason I am asking is I have read that the younger you are in being diagnosed with P Cancer, the more aggressive it turns out to be.
My Uro says we will be doing a transrectal ultrasound guided biopsy - 12 core. How come you decided on no active treatment?
I was 63 at the saturation biopsy stage when the official diagnosis was made. I'm 68 in June this year.
Remember that a biopsy carries with it the risk of infection. No point having it done without good reason. Cheers Richard
Exactly and you should have a Template not the Trus biopsy you are having although frankly there is no need to have either yet
When I was talking to the doctor today, I asked if we should be doing a fusion biopsy (something we had talked about a few days ago), and he said based on my MRIs that it wasn't needed as the problem areas were pretty common and fit the template. I kind of assumed that meant a template biopsy? Is there a difference between that and a transrectal us guided biopsy?
I think he meant you don’t need either type.
Ok thanks everyone for the replies. I wanted to add what my MRI report says:
"MRI Findings
The prostate gland is normal in size, measuring 3.68 x 2.8 x 3.77 cm (TS x AP x CC) with a calculated volume of 20.3 cc.
Wedge shape T2 hypointensities are noted in bilateral postero-medial peripheral zones at mid-gland and at the postereomedial and posterolateral peripheral zone of left apex. These have indistinct hypointense signals in ADC and do not exhibit early arterial enhancement on dynamic contrast study. Findings are of low suspicion. PI-RADS 2 (clinically significant cancer is unlikely to be present).
The neurovascular bundles at both sides appear symmetrical. Seminal vesicles are normal and symmetrical. The rectoprostatic angles at both sides are not obliterated and the anorectum canal is normal.
No definite pelvic nodal enlargement seen.
No discernable signal change seen in visualized pubic bones."
And in the comments section it says:
"Wedge shape T2 hypointensities in bilateral postero-medial peripheral zones at mid-gland and at the posteromedial and posterolateral peripheral zones of the left apex. These have indistinct hypointense signals on ADC and do not exhibit early arterial enhancement on dynamic contrast study. Findings are of low suspicion , PIRADS 2 (clinically significant cancer is unlikely to be present). However microscopic disease cannot be excluded. Biopsy is recommended if it is clinically inidicated."
So I'm not really sure what all that means, but it doesnt seem too bad??
Basically it means just get on with your life and stop worrying. Far more danger crossing the road and driving!
Good luck, Richard
I know how scary the words prostate cancer can be. It really does not look like your stats are that bad. Even though rectal exams do not always detect tumors, (nine didn't but I did have one) your other test all came back looking pretty good. Maybe you should find out if there could be something else causing your hypointensity signal. No need to worry if there is nothing to worry about. You really don't want to get a biopsy if you don't really need one. I would trust your doctor on this one.