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

Posted , 6 users are following.

rolf61809
rolf61809

That's the part around the urethra. It seems that my PI RADS level 3 means inconclusive. ( it can be from 1 - 5 ,5 being it's pretty sure you have Cancer. My PSA was 6.5 a year ago (it had been slowly creeping up), then 3.5 four months ago. The urologist was all , ' great news', but I was more concerned that it was bouncing around. Then a month ago jumped to 9.5. Then they started talking blind 12 core biopsy, because 'the insurance never covered MRI's prior to the first biopsy'. I raised a stink and told them to submit it anyway, and lo and behold, my plan did cover it. This all started as year ago with intense pain just like my previous ( every 5 years or so) bouts with acute infectious prostatitus. And this time the DRE's were nowhere nearly as painful as in the past. So now they are talking about still doing the normal blind 12 core biopsy. Makes no sense to me, why not target the transitional zone? And my question for all you good folks is what the best kind of biopsy for me now? Or I have the option of doing nothing now and repeating the MRI in six months. And they were perfectly willing to wait three months to check the PSA again. I'm not, if the MRI had been clean I wanted to check the PSA monthly and do the biopsy if it kept rising. Besides, my current COBRA policy expires in four months, and good luck getting insurance with a cancer diagnosis. Please, if anyone has any knowledge or experience in this area, please enlighten me. I just found out about the MRI this afternoon, and need to make informed, good decisions ASAP. So many kinds of biopsy's out there, and I don't think I can afford to make another mistake, my first being sticking with the first sorry urologist for six months. Sorry for the length, I'm just trying to order my thoughts. The battle begins tomorrow.

0 likes, 43 replies

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  • Tybeeman
    Tybeeman rolf61809

    Posted

    Dude I don’t know what kind of doctor you are seeing but he isn’t very good. I hope he is at less a urologist. That said, any doctor will order you a PSA test. You are not reading my responses. That pain isn’t coming from a cancer. I have been waiting out my high PSA for 12 years it was only last November that it spiked to 11 that I did the MRI. Along the way I had 2 biopsies that I now wish I never had. I never had any pain except from the biopsies. If you can get a MRI, you will find the cancer but it will not tell you a Gleason score without an ultrasound-guided prostate biopsy using soft image fusion ultra sound. One other thing before you go off halfcocked. Anyone can give you a MRI, but there are only a few places that are good at it. You will need to find one. I live in Savannah Ga and had to drive to the Mayo clinic in Jacksonville Fla. This is want you need and you can google it. (MRI and ultrasound-guided prostate biopsy using soft image fusion). Find a doctor that can do the biopsy then get him to send you to the right MRI imaging center. I am going to say it one more time. THAT PAIN IS NOT COMING FROM CANCER That is a whole different problem.
    • barney34567
      barney34567 Tybeeman

      Posted

      Hi roff,

      i wish to echo tybeeman. MRI ultrasound guided fusion biopsy is the way to go. I recently had that. It is the most definitive biopsy possible.

      And from what I read, tybeeman is right when he says the pain is not coming from cancer.

    • rolf61809
      rolf61809 barney34567

      Posted

      I never thought the pain was cancer related, just prostate or epididymis related. Or possibly pudendal nerve related. But I've been dealing with it for a year, and now this 3.5 -> 9.5 PSA and pi-rads 3 crap comes up and sort of puts the pain in the back seat. Are they related? Well, stress and pain can affect PSA. And pelvic floor disfunction. But pain directly from a possible cancer, I don't think so.

    • barney34567
      barney34567 rolf61809

      Posted

      Was the MRI radiological report prepared by a specialist in prostate imaging?

      I ask because if he is a specialist and he is sure your PIRADS is 3, then you should find a urologist who should look for a non cancerous explanation for your symptoms.

    • Tybeeman
      Tybeeman rolf61809

      Posted

      A high PSA score does not mean cancer. If you irritate the prostrate in any want if will give you a high score. Infections can cause a high PSA along with an activity.  I read were Lance Armstrong’s PSA was always in the 40 to 60 range. No not 4 to 6 40 to 60. I got concern with mine at 11.
    • rolf61809
      rolf61809 barney34567

      Posted

      Saw two urologists at Cleveland clinic today. They don't do transperineal prostate biopsies. The junior one was ' let's do the biopsy so we can rule out cancer', and was abashed when I pointed out that biopsies miss 30% of cancers. ' damn the Internet' I saw him thinking. And the senior one was all gung ho like ' let's do the biopsy so you don't have to worry '. Same comment from me. WHY wouldn't they be more honest??? Glad I demanded the MRI from my current urologist. The CC boys agreed that being a fused biopsy was superior to the blind one but the first one was pushing. Sticking with my plan going in of getting another psa in a few weeks and if it has continued to rise from the 9.5 of a month ago to get the fused biopsy. And I got referred to a urologist/ pain specialist who I'm seeing before any biopsy too. The two today both not mentioning the biopsy miss rate is p*ssing me off. Or the fee percent of biopsies which result in really nasty and hsrd to treat infections. And their, ' well, we'll just yank the prostate' attitude. Of course, it doesn't take alot to p*ss me off these days.

    • geoff90305
      geoff90305 rolf61809

      Posted

      Yeah Rolf, the attitude of some of these guys not too impressive. At least they are eager to do some thing.  They seem to think we are idiots and do not research the internet, which has lots of great information, like this forum. And yes, once you gain a bit of knowledge, people with a less than honest attitude can p*ss you off, very quickly.

      As for the biopsy, If you are going to have one, then the most accurate, and less needles as possible will 'reduce' the chance of infection. Good luck with the biopsy. Be interesting to see what Gleeson score you get, compared with the MRI PIRAD.

      Geoff

    • rolf61809
      rolf61809 geoff90305

      Posted

      Yeah, I'm usually pretty laid back about things, with the exception of people lying to me. And doctors I hold to a higher standard. Less than the full truth is a lie. Seeing the original urologist I browbeat into doing the 3T MRI today. Don't think I'll mention the ' second opinions ' I got yesterday, just to see what he says. It will indeed be ' interesting ', but for me I have to work though ' terrifying ' first. If the next psa in a few weeks is higher I'll do the biopsy for sure.

    • geoff90305
      geoff90305 rolf61809

      Posted

      Hang in there Rolf.

      I was similar with my urologist. He said, 'we will sort it out in October, when I can see you'...bloody hell, I can't wait for a few months with a PSA rising like it's going to the moon. I will get an MRI...give me a referal. And the rest is history. I can see him now in October with a some what easier state of mind.

      ?I need to do some sums about prostate density and work out what the PSA per prostate cc etc is. Saw some thing on the net in my travels if your PSA is high, you can work out PSA.

      Off to Canada next week until end of September. Worry about it all when back...liar...every day you think about it.

      Geoff

       

    • barney34567
      barney34567 rolf61809

      Posted

      I can't recall your earlier PSA scores but suggest that you list the PSA scores over the last couple of years. The question I have is: how long did it take to double? From my reading you had 3.5 last year and now it is 9.5

      If that is so, I suggest you find a urologist to refer you to a MRI ASAP. If the MRI is suspicious for cancer then motor on with the biopsy. Transperineal MRI targeted ultrasound guided would be my choice.

      I would try to do this ASAP and not wait until October.

    • rolf61809
      rolf61809 barney34567

      Posted

      Year ago was 6.5, four mo ago 3.5, Six weeks ago 9.5. neither current urologist nor Cleveland clinic urologists do transperineal, just transrectal. If psa reading in two weeks continues to rise then da*n the torpedoes and will to the fusion transrectal.
    • rolf61809
      rolf61809 barney34567

      Posted

      Yeah, I did have the MRI and pi-rads level 3 in the intermediate zone. And will have to settle for the transrectal fusion biopsy.
    • barney34567
      barney34567 rolf61809

      Posted

      I see you're keen on another PSA test in two weeks. From my understanding of the topic, it is preferred to space PSA tests three months apart.

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