Hi Can anyone tell me more about PI-Rads scoring after an MRI scan on the prostate. My husband has been graded a 4 and it waiting for a biopsy the one done under a general anaesthetic. I have not been able to find out much about it other than 4 means very likely that clinically significant cancer will be found. We we spoke to the specialist nurse she also said that there was some concern over pelvic lymph nodes. Not sure if she meant swollen or they thought there was cancer. Bone scan was negative. Background on my husband age 71. Hight psa's since 2002 ranging from starting point of 4 and rising over the years with scores of 7, 14,19,21 and 2016 38. He was diagnosed with enlarged benign prostate and has had 2 negative biopsies over the years and 2 negative MRI scans. The only thing found was lot of inflammation noted on biopsies. Last year when it rose to 38 he had a negative MRI scan which the team looked at and thought it was all down to the inflammation and the prostate size. We have moved house to a different area where the recent MRI has been done. I should add that he was given finasteride 2016 to reduce the size of the prostate and his last reading was 26. The consultant says that drugs reduces the psa reading by 50% which means the true reading would be 52. In the letter sent to our gp which we have a copy of it just says if psa rises 20% above presenting level of 38 to refer back. I should add that my husband has other health problems namely type 2 diabetes, asthma/copd and is overweight. Obviously we will have to wait until the biopsy is done. He is not keen as he had a reaction to the anitbiotics hence the MRI scans. He also has to have a pre assessment to see if he it fit for general or maybe an epidural. It is all very worrying and can't seem to read about any patient with a similar story. All I read is about men with psa under ten being diagnosed with advanced cancer and or those with readings in the 100s or 1000s. The nurse mentioned if it was cancer and they seem to think it is then maybe radiotherapy or hormone treatment both of which seem to have bad side effects. Not sure but think that he would not cope very well. I can't seem to find anything much about inflammation with no symptoms and high psa readings either. I should add that I have read that the drug finasteride can cause agressive cancers but protect against non agressive ones. Also he takes a spiriva inhaler for his asthma since Sept 2015 and there are reports of it causing problems with prostate and psa spikes and cancer. The consultant said it does not. I have asked the nurse to do some research for me for when we go back. This is a long and complicated post and unfortunately my husband is not type to want to find out about anything even if he is diagnosed so I try to find out and be prepared. If anyone could comment I would be grateful I did post in the Prostate problems forum about 1 year ago and just recently as well which give more details. Thanks for reading this sorry I have gone on a bit.
Wow Libralady. That's a lot to talk about and I'm trying to think about where to start!
PSA is not a definitive measurement but a useful guide when either rising steeply or when the condition is defined. A lot of things from benign hyperplasia to infections to just having intercourse will raise it.
PI-RADS scoring is a little complex and involves several things. To quote:
The score is assessed on prostate MRI. Images are obtained using a multiparametric technique including T2 weighted images, a dynamic contrast study (DCE) and DWI. If DCE or DWI are insufficient for interpretation, the newest guidelines recommend omitting them in the scoring 6.
A score is given according to each variable. The scale is based on a score from 1 to 5 (which is given for each lesion), with 1 being most probably benign and 5 being highly suspicious of malignancy:
PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present)
PI-RADS 2: low (clinically significant cancer is unlikely to be present)
PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)
PI-RADS 4: high (clinically significant cancer is likely to be present)
PI-RADS 5: very high (clinically significant cancer is highly likely to be present)
You have just given the PI-RADS score but perhaps have the other results omitted (eg DCE, DWI - though these are omitted if unclear).
You are right that clinically significant cancer is likely to be present, but this may be a very slow growing adenocarcinoma entirely within the capsule. Actually the MRI should indicate whether it is likely to have an extra-capsular extension or not.
The fact that there are indications of lymph node involvement show that there may be some concern regarding the stage. You really do need the biopsy results to get a better indication on this and on the implications regarding the best way to manage this (one form of management may be suppression of testosterone upon which prostate cancer relies).
I hate to say this to you, but you have to take one step at a time with this or you will always end up making the wrong conclusions. It seems to have been a long story and one that indicates why mpMRI is so superior to conventional MRI.
Please feel free to PM me if you feel it could be helpful at any time. I feel that this is one of those awful mismanaged cases due mainly to ignorance rather than anything else.
Feel for you, Same here. My husband had an MRI level 3, equivocal, elevated PSA levels from 11+ up and down and then up again, An enlarged prostate, Hospital doctor said 3 is a 50/50 chance of something or nothing and 4 is a higher percentage and 5 is almost definite cancer. I don't know what PI-RADS means but I am going to look it up. We are waiting for a template biopsy with general anaesthetic, have had a rectal scan of prostate with dye, and will be having another MRI before biopsy as my husband has been enrolled in a clinical research trial, otherwise it would have been a TRUS biospy but we decided to delay and pay for a private MP MRI but hospital said they would do this in there clinical research instead when we told them of our intentions.
My husband just goes along with whatever they say and then I research things and say whether or not I think it is the best approach, but sometimes I wonder if I am just confusing the situation for us both, Hopefully it is better to be informed than not.
It's a wild roller coaster ride and sometimes very confusing. Hopefully for all of us it will be okay please God, It is an anxious time.
This post is for all who were good enough to reply to my original posting about PIRADS scoring. At last 4 weeks after biopsy we have a follow up appointment to see the consultant for my husbands biopsy results. I am expecting bad news, although my husband if confident it won't be. The nurse at the last clinic appointment mentioned the possibility of radiotherapy or hormone treatment. Having read up on both I am really worried about all the side effects. The hormone treatment seems to have hotflushes,tiredness,risk of Diabetes, weight gain and breast enlargment. The radiotherapy urinary and bowel problems which could be permanent. My husband of 71 is obese so needs to lose weight not gain it especially as he has type 2 diabetes and asthma/copd. At long last he is on a pulmonary rehab course which will last until around the end of September.
The course includes exercising, diet and treatment. It has taken me a long time to get him to agree to go on this course and I was glad he was finally accepted as from what I have read from other sufferers he will benefit greatly. Back to the hormone treatment would you think he would being suitable for hormone treatment given the side effects and his other health problems. Like wise the radiotheraphy side effects he already has some urininary problems although not bad from his very large prostate. I know him very well as I don't think he would be able to accept these side effects. Can you suggest what questions we should ask if he needs treatment I am so frightened of making life worse for him but realise he may need treatment. Any views would be appreciated.
Update on my husband. Went to see the consultant this afternoon. Good news the biospy( 24 samples taken) no cancer was found. The worrying thing is that his PSA seems to be rising. His prostate is 200cc? according to the consultant. I asked about correlation between prostate size and psa level but he said he could not really give me an answer. He suggested he see my husband in 4 months for a psa test and a urine flow test to see if he is retaining urine. It is then up to him if he has a Transperineal ultra sound guided biopsy (which I think he should have had last time but it got changed). He mentioned that the more biopsies ae taken the less chance there is of finding cancer but said that tthe type of biopsy proposed can find cancer which the ordinary ones can't. I think my husband has already decided that he would not have any more biopsies after the last one. It will be his decision but I can undertand that at 71 and with other health issues he has had enough. In the meantime I might do some research into benign causes of high psa. Anything any one can add would be appreciated.
My husband only got offered the transperineal biospy as he was reluctant to have the rectal, well basically near refused, so they offered it when we said we would try to get another MRI done privately as they said he didn't need another one, the last was taken over a year ago, then the professor of urology got involved and said he could have one done as they were doing a clinical trial that involved MRI, ultrasound and transperineal biopsy. I guess cost is involved as the clinical trial is being funded by the researchers.
It really is a merrygoround trying to find out what to do for the best.
Hi I did not know about the pi score,I looked it up and Romney
J really explains it well.im 68 now
I was 66 when I had T2C Gleason 9.i had open prostactomy . Now 2 years on wear the thinnest Tena man pads one lasts all day.i had lucky escape psa ever since opp is 0.05 undetectable. I hope your husband does as well .best wishes . Vin
Update on my husband, As I mentioned earlier he had a routine following with the consultant. His psa had reduced a bit from 26.9 to 20.7 which as they have told until needs to be doubled because he takes finasteride, although I am convinced on that. They did say is prosate is 200cc now they are saying it 149 so it had reduced by half but maybe I have it wrong. Any he told the consultant that he would not have any more biopsies neither the new transperineal and certainly not the rectal one as it affected his bowels. He has agreed to once more to regular psa testing and will go back to the clinic in 6 months. He decided not to have the biopsies 4 months ago but in December he had a suspected TIA (mini stroke) and although thankfully he got the all clear after mri testing and doppla carotid scan (they now think it was a migraine) it has made him even more adamant about refusing the biopsies. He will in 72 in a few weeks and feels that enough is enough. I hope everyone is happy and well.
Simply put, as regards your husband:
1. PIRADS 4 on 3T MRI means a biopsy will reveal PCa
2. Whether the PCa is confined to the prostate is a good question
3. A biopsy (mri guided transperrieneal ideally) will reveal a lot and confirm or deny PCa
4. A biopsy is a BIG deal
5. If you have a biopsy then it must be performed by he who you would be happy to operate (even if you're not thinking surgery)
6. Before any treatment (if that's what you're thinking), I would undergo a PSMA PET CT scan. This is proven to be a very accurate tool to diagnose any spread of the PCa.
7. Bottom line, if the PSMA shows (heaven forbid) cancer on the spine then you can ditch the biopsy and consider either systemic (eg hormone) therapy or do nothing (if he has other maladies going on).