3t prostate MRI showed PI RADS Level 3 in transitional zone.

Thanks. I get that it's slow moving, but who knows how long it's been going on? My PSA did jump from 3.5 to 9.5 in the last few months. It's hard to keep a level head with the horrific pain. It's like the worst attack of acute infectious prostatitus I ever had, but instead of it peaking for a day or two it's been 2 to 3 days a week for the last year. And on the 'good' days I still feel like sh*t. And I could be one of the lucky few who actually have cancer without the accompanying skyrocketing psa. (Should I ask for the free PSA test?) Sorry to be so whiny. After a year of my griping it's like the DR's were tuning me out. The only good thing about the MRI is that just maybe they'll start taking me seriously. I also get that they probably get alot of hypocondriacs who present the same way I do. I just cannot continue to function at this level of pain. I'm a computer programmer and need to get back in the game and get another contract. Thanks again for the advice. I really do appreciate it.

Hi Rolf, Yes the rising PSA is a worry. Great you got the MRI and that it was covered by your insurance. Here in Australia, Prostate MRI are never covered by insurance or the Government. We pay the $500.

Your PIRAD3 score gets you into the "not sure if there is some thing" area. Did your report from the radiolgist state they found any lesions? If so, they could be targeted for biopsy. Your report would have mentioned where the less than normal tissue was, also a target for the biopsy. My urologist said he don't do blind biopsies. He prefers a target. If a lesion was reported, then it is back into the MRI machine with a robotic biopsy that needles the dodgy area and takes a sample, then a more definitive result available in a day or so.

My PSA has been steady around 2.4 for 13 years. A few months ago, got a big UTI, and the a few weeks after subsidence, my annual blood test showed my PSA had risen to 7.4, repeat test a month later, 8.2 then 2 months later, 12.0 and a free % of 12.5 Ummm, Not looking good, though the UTI may take a long time to settle. I arranged for a mpMRI. A day later, the report was released. It said I was developing BPH in a few areas of my prostate, and I had a PIRAD2 score as well as a prediction of no Gleeson 5 or 6 was evident. So, sort of good news, but, the rising PSA still needs resolving. Maybe the BPH tissue being created is the cause? In October, I meet with urologist to see how we sort out the reason for the PSA. Other than PSA, I have no problems at all.

Apparently the free PSA is good for a PSA level less than 10, so may assist you with your quest. 

Geoff

Sounds fun!!!. I saw a youtube on this procedure. If you have to have a biopsy, while this is a serious way to get one, it looks the best way.

So, Tony, do you go on a waiting list for this procedure, and if it is classed as urgent is it done within so many days of original presentation to the clinic?

Geoff

Hi Geoff, I only had the neg results from the 12 needle biopsy yesterday, (don't know if there is a prescribed amount of time to wait between biopsies). The doc says that they'll be sending me an appointment letter....The NHS stumped up for an MRI unbidden and have spotted a small lesion which they have graded as PIRADS 4 (ie likely to be malignant), which begs the question why not do the saturation biopsy in the first place?....It's the waiting that gets to you...It's getting depressing.....plus you can't help but think that why they are dicking about this thing is getting bigger....Just want to get it sorted....They obviously think there's something there....Why not cut to the chase and get me to sign on the dotted line and get the prostate out? (I'd do it tomorrow)

Tony

Hi Tony, If they have found a lesion, then this should be biopsied, which will give them and you the Gleeson score, which in turn will give you the urgency or otherwise action to be taken. Your cancer, if you have one, could be very slow growing.

If you are a NHS patient, like a public health patient here, you are some what limited in your demands of the system. In Australia, if you present to a public hospital with a 'high' PSA, and a MRI indicating a lesion in the prostate, the hospital urology clinic will, within 14 days arrange a detailed biopsy of the lesion. Depending on the biopsy of the lesion, action to remedy the prostate will be carried out within a further 14 days if the biopsy indicated urgency.

Good luck

Geoff

Hi Geoff, as you will see, I've already had a 12 core biopsy which found nothing, but aparently there is a false negative rate of about 30% on 12 needle biopsies....I have a 70cc prostate so it's 2 and a half times larger than the norm.....My PSA which I have read every 6 months because I'm on the cusp at 3.1 (I'm 58) has been constant for the last 3 years...I got complacent and left it a year, went to the doc and had a nasty surprise 7.5!!! .....while waiting for the NHS to get into gear, I went to a private clinic to get retested with a free PSA reading and it came back 4.3 with a free PSA of 23% (two weeks later)....I thought then that I was out of the woods.....Then the NHS got hold of me and after a cystoscopy, a CT urogram, an mpMRI which showed up the small suspicious lesion and now a biopsy I'm still in the dark......From what I read anything that shows up on an mpMRI is "significant" (assuming the radiologist is doing his job), so I want to get this sorted sooner rather than later....especially as I'm now getting a pain in the lower back and hip which is freaking me out (hopefully it's just my age, but the mind starts to imagine the monster under the bed).....Plus joy of joys, in the last three weeks I have incurred an inguinal hernia.....Someone somewhere is having a cosmic joke at my expense....To be fair the NHS has been pretty good and fast, but when you hear the word "Cancer" you can't find stuff out quickly enough.

 Rolf....Sorry for Hijacking your thread, but this may help someone out re :Pirads and tests etc.

   Tony

I mean that they should biopsy the lesion by a guided biopsy, as this is the spot that has lit up the MRI.

My brother's PSA over a 3 month period went up to 37, then over three years came back down to 3. Apparently, chronic prostatitus. Mine from 2.4 to 12(at present), so, maybe the same issue.

Geoff

And...thinking about your comment pains in the lower back etc. When you had the MRI, he would have used a contrast late in the test. As I sit here, my lower back sore as well as bum bones. Radiologist made a point of saying, the contrast test will show any hot spots in the pelvic area bones. His report said no hot spots. I am sure your guy would have said if he saw any. Don't worry...too much.

Geoff 

Hi Geoff, I don't even know if that kind of guided biopsy is available in the UK....I know we're not quite a third world country (yet) but I've never seen that option mentioned anywhere in the UK, either Privately or on the NHS....Even the fancy Harley St Clinic where I got my PSA retest only offer a standard or saturation biopsy on their website.....As for Prostatitis I have offered that possible explanantion to 4 different urologists now...The guy who did my cystoscopy, the guy who gave me the MRI results, the guy who gave me the biopsy and the Harley St consultant (who happens to be one of the worlds leading experts on the prostate) and they have all sort of shrugged and remained very non-commital...When I told the doc yesterday about my inguinal hernia and whether I should go for the consultation with the surgeon, as I had read that inguinal hernia repair and prostate surgery (should it come to that) don't really go together....he said "you've done your homework".....I said "why wouldn't I? this is my life"...I nearly added that it "shouldn't be just left to the trust of doctors", but thought better of it. No matter how good the doctor if something happens to you, they'll still go home at the end of the day and have their dinner......Cynical   Moi?

   Regards and thanks for the post.....Tony

Hi Geoff, Just noticed this....You may be right but I thought that the test for hot spots in the bones was different......They use a radioactive medium and then a special camera as I understand it......It's probably just paranoia (hopefully).....

NP... Call me a cynic, but I suspect it's all about the money, not getting the best (more expensive) test first. Tho I get the 'greater good' argument, that more tests lead to unnecessary surgeries. (Though, come to think of it, that's all about the money too, if you're a doctor or hospital). I'm getting herded to a transrectal biopsy, getting nowhere telling the urologist that I can show him 20 studies showing the sepsis/infection rate vs transperineal is significant. And that there are areas of the prostate much more accessible via the transperineal. I guess I'm in the 'lesser' of the 'greater good' equation. No financial incentive for the transperineal approach, yet... thanks for the input guys, it's a tough learning curve.

Hi Rolf, I had the same feeling that the transperineal was better, but of course, much more cost involved. The transrectal is more like the conveyor belt stuff. While it can be guided via the MRI image, still not an ideal way. IF you have to have a biopsy, then it should be the one that gives you, the patient the best result(biopsy and infection control) for the least cost. So far, I have not considered the need for the biopsy...yet. Also, it depends where your lesion is. If not accessable to the transrectal method, then should use the transperineal method.

To biopsy or not is a good question. Do you rely on the MRI findings? The biopsy could say the lesion is deadly, but very slow and could be watched for several years before it needed attending to. Many men do not like the fact it is there...get it out of me. Though, the aftermath of the treatment choice needs great consideration before getting on the table.

Geoff  

Thanks Geoff, my psa has tripled to 9.5 this year, and I have the 'pirads of 3 in the intermediate zone'. Nice lady that the urology asst is, she only read the words, and noted that no areas of specific interest were indicated. I was a little p*ssed that for a positive screening result the doctor didn't feel the need to make himself available. Probably because he knew from experience that anyone in my place would ask a bunch of fool questions and put him off schedule. Well, that was two days ago and she hasn't made the promised call with answers for the questions I did have. So tomorrow she's hearing from me. Dammit, I have to be polite... I need their full attention and cooperation. Tho I did make an appt with a urologist at the Cleveland clinic for next week. Had a l2/l2 nerve block today for the prostate area pain which I cannot see helping (there should have been temporary pain relief I think, tho maybe the steroid component of the shot will kick in - I'm not optimistic). But I had to start playing their pain game so I can say ' yes, I've tried that...'.

medical issues don't seem to have the common decency to wait for their turn, but instead gang up on you. The pain thing has worsened over the last year - the PSA jump just a month ago.

Rolf, Here in the UK where our treatment is "free" (paid for by taxes) I assume that it is a cost issue (although they gave me an mpMRI which surprised me). To do the transperineal is obviously more expensive as it involves more personnel, anaesthesia etc.....I would have thought that irf you were paying they would give you the best treatment straight away.....Especially when you consider the mental angst every time you have to have a test and then wait for the results....Tough learning curve is right

    Best Wishes

Tony, So, from walking into the hospital,how long did it take them to start the diagnosis train, and did they jump straight into the biopsy and did you give up or not trust them and went to the Harley street guys?

Geoff

 

Geoff, It's a long story....but you asked for it....I first went to the docs 10 years ago (48 years old) because of issues regarding frequent urination.....always looking for toilets when out etc. Doc did a DRE and a PSA....rang up surgery few days later....the girl said "everything fine"....Did the guy thing breathed a sigh of relief...didn't ask any questions....things never really changed just got used to them....Then went to Docs nearly three years ago (7 year gap now 56) with getting up in the night etc. DRE and PSA,,,,PSA comes back at 3.3.....Doc wants to send me to hospital...I freak a bit, ask for retest because of sex and riding my bike less than 48 hours before....retest comes back at 3.1 (3 is the cutoff in the UK for my age group).....Still stupidly don't want to go to the hospital, so ask the doc if we can do retests every 6 months....She agrees......next 3 tests all 3.1....Got complacent left it a year and then in June of this year went to the doc....PSA now 7.5 (Panic stations)...My regular doc away so other doc orders some tests for urinary infection etc. Gives me a bottle for morning urination....In the morning as I'm peeing in the bottle I pinch the end of my penis to stop the pee overflowing and I notice a small amount of blood at the tip of my penis (After careful reviewing I now believe that this was just me squeezing the tip too forcefully, but at the time I thought great it IS a urinary infection)....Later on that morning the nurse takes the bottle and dips it....says "No infection" but the lab will be able to tell us what is wrong.....Couple of days later I get a text on my phone saying regarding tests "No further action".....I "Know" that there was blood in the urine so how can that mean "NO further action"......fly up the docs....explain everything to another different Doctor.....She is a bit young and possibly inexperienced, sees this guy who's in a bit of a "flap" so refers me to the hospital on the 14 day scheme (whereby they determine to get the ball rolling within that time)......In the interim I'm doing lots of research and learn of the free PSA test.....The NHS don't do this, so I found a clinic in Harley Street who specialise in the prostate....travel to London, have the test, go back the following day for results and a consultation with their big cheese....PSA (from their lab) now 4.3 with a free PSA of 23%.......The consultant (who is a world renowned expert on all things prostate over  1000 robotic surgeries, books, scientific papers etc). spends 30 minutes with me ...bit of history, trousers down assume the position.......DRE says unequivocally "No Cancer"...He also says that if I want to know what's going on with the prostate he can arrange an MRI and it will cost about £1700.00...I agree that I probably will do that (Now that it isn't cancer I would like to know what is the next move)...Needless to say I skipped out of the office.....Get home to find 2 letters from the NHS one booking me for a cystoscopy and the other for a CT urogram..I'm of a mind to cancel......My wife makes me go....The cystoscopy doc does the test says "well you dont have bladder cancer" and  books me in for an mpMRI and a biopsy.....(Now I'm really concerned)......Cystoscopy results arrive the following day No problems...Have the urogram......decide to go for the MRI (I'm saving £1700.00 remember) but in light of the Harley St consultants good news, I ring my hospital consultant via his secretary, email her my new test results and ask if I can defer the biopsy until after the MRI results (figuring that it will be clear)...The hospital consultant agrees.....I wait a couple of weeks and go to hospital for my results, only to be told that there is "something" on the scan......so did I want a biopsy now or leave it until my next PSA test (I did not know at this stage that I had scored a 4 on the PIRADS scale).....I decide to go for the biopsy and the rest you know....This has all taken 7 weeks, it would have been 3 weeks quicker if I hadn't deferred the biopsy so I cant really complain about the speed of events....The strange thing is I don't think I would have been here if I hadn't reported the blood in my urine.....(the blood didn't show up in the test)....My own doctor said she would have left it a few weeks and retested me, so maybe I'm the master of my own downfall, Life is a lottery aint it......Sorry to be so long winded

     Regards Tony

Rolf, A tripled PSA is a concern. Mine went from 2.4 to 12 in 4 months. Dr says a rise this amount in a short as time as mine is always a protate issue of some sort.  As my MRI is PIRAD2, maye correct?

Did you get the DVD with the images of your scan? With the software provided by the radioligy people, you can view each image in great detail. I compared mine with those on the net. Interesting, yet scary, as hoping not to find anything that looks like a dodgy example on the net. I guess these medical people see hundreds of patients a week, and sort of lose touch with humanity. For us, super important. It is our life. It is all well and good for people to say, don't worry, it is slow growing...usually. Well, it just might be in its fast phase now, so lets not stuff around and get to a final position so YOU can make some decision.

What sort of pain do you get? I never get any symptoms...yet, so, maybe my BPH is late starting.

Geoff

Hi Rolf, The sudden jump in PSA and the pain would point to prostatitis....especially as you have a history of it.....Do you know the size  in cc of your prostate? This has an impact on your PSA reading.....also do you have a free PSA percent figure?.....I'm sure you realise the higher the better.....a PIRADS 3 just means that the radiologist can't make his mind up....So it's neither Positive or Negative But you're right about medical issues ganging up....3 months ago I considered myself pretty fit, not a health care in the world....I'm now looking down the barrel of a PIRADS 4, an upcoming trans-perineal biopsy, an inguinal hernia that appeared 3 weeks ago and an increasing pain in my hip (which is freaking me out in the light of the PCa thing looming like the sword of Damocles

   Hang in there....Tony

Pretty quick really Tony. As I said earlier, you need some better advice about that PIRAD4 lesion. May only be BPH, but then again, if it is a malignant version, it needs seeing to...soon. See if you can get a biopsy of this lesion asap.

Geoff

Geoff, reading your post....A Pirads of 2 isn't bad in the scheme of things, if you look as to how they score ....It means that it's more than likely to be benign.....I wish mine was a 2....I'll swap you anytime....again from what I read a jump of 2.4 to 12 in 4 months has to be infection.....If it was something sinister working that quickly, your MRI would be lighting up....They'd have to create a new scoring system just for you

Hi Geoff, I've had a few people tell me that they've had a similar situation and it turned out to be BPH....Trouble is the genie is now out of the bottle....I don't know what to believe....Had the urologist told me the other day "off you go" I'd have been happy to believe him....I imagine they won't leave me twisting in the wind too long....They've been pretty quick so far.....It's the waiting that plays havoc with your mind

   Best wishes   Tony

The pain.... started a year ago was like worst attack of acute infectious prostatitus that I have ever had, which in the past always resolved after a week or so. Not this time - level 4-7 pain all day. No UTI'd or std's. And last six months epididymis pain mostly on right side anywhere from 3-7. BUT, the DRE's aren't painful at all like every one I ever had in years past where I was like the cat with its claws on the ceiling. Maybe it's some superwierd bug they never tested for? Oddly enough triazepam does seem to help with the pain.

Can't recall if I mentioned it earlier, but the Transperineal is to be preferred over the trans rectal biopsy because it is known to lead to less instances of sepsis.

hahaha, yes, my doctor said the PIRAD2/no Gleeson 4/5 evident score is about the best to hope for when you are 68. To get a PIRAD1, you need to be younger. My family doctor,55, is also having prostate issues. We discuss each other's issues as a comparison as friends. His PSA has been steadily rising over the last two years, with a low Free PSA. He says his is typical of problems, while mine is too fast and strong. I need to convince him to get a MRI.

Stange really, for many years he said when ever I wanted a PSA test, it was usless, as nothing can be done!!! My logic has and is, if you find a problem early, it is always easier to treat. By the time symptoms appear, it usually is too late.

Saw you other comment about the genie. I fully agree. While the PSA is within bounds, you tend to ignore. BUT, when the PSA goes outside the boundaries OR outside your average PSA by x %, then you are now for ever on a, 'lets just check this" routine. If you have any pain as well, now that would be terrible.

Geoff 

Rolf, this would be terrible. Waking up to this every day, maybe through the night would be exhausting. It is like the doctors need to get a prostate discharge sample in the lab and see what grows. There are so many guys out there with prostates giving trouble, other than PCa, seems strange there is not a better pain management program.

Geoff

Agree, but you do not see it performed that often. Maybe a cost reward thing for the doctors? If I needed a prostate biopsy, this would be my choice. Will be more expensive, but less chance of asepsis and can get to the often problem area of the prostate.

Geoff

I'd be happier if either of the urologists came clean and just said ' we don't do transperineal biopsies '. What frosts me is their ' transrectal biopsies are just as good and the infection rates are the same ' bullsh*t. Even if the infection rates were the same seems like you'd get nastier bugs transrectally.