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.