MRI PI-RADS scoring
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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.
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libralady13
Posted
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.
anne05147 libralady13
Posted
Anne. xx
rich22 libralady13
Posted
thnx for the update. i just turned 71 and know exactly how your hubby feels. i think we all get to the point where enuff is enuff - i managed to stop 3 other kinds of cancer in their tracks but this PCa is a horse of a different color. i'm willing to have 1 biopsy, with needles guided by live MRI scanning ONLY. that way, they reduce the number of stabs. why there are only about 5 - 6 doctors that do this in america is beyond my comprehension. this technology's been here for over 5 years!! if my pc has spread, i'll see about my options then. already scheduled for bone marrow chemo (a thalidomide derivative! imagine that!) so not sure i can mix and match radiation, hormone, whatever the h3ll else they have... so yeah, enuff is enuff. putting it all in God's hands after this.
my prayers are with you and hubby.
libralady13 rich22
Posted
Thank you for your reply. You have had more than your fair share of the Big C. I think you are wise to to opt for the biopsy guided by live MRI scanning, you have obviously thought about it a great deal. As you know here in the UK things are a bit different under the NHS. The biopsy my husband was offered was a Transperineal ultrasound guided biopsy. Is this the same thing? It is only done at one hospital. Reading through the leaflet we were given it seems that there are a lot of potential side effects. It would seem that this type is only offered after you have had a negative rectal biopsy. The consultant said this can detect cancer in a place where the rectal ones can't, although one of the side effects lists failure to find a cancer. The consultant when he gave him the negative result of the saturation rectal biopsy said that when the team had discussed his case they had decided that he could choose between the transperineal biopsy, regular PSA testing and if necessary MRI scans. After my husband had the last biopsy he said never again that's enough and taking into account his other health problems I can see where he is coming from. He will have another PSA and see the consultant in 6 months time.
I wish you well for a good outcome and I am sure you will make the right decisions as to treatment or no treatment which is right for you. Please let me know how you get on. In the meantime keep well and positive.
rich22 libralady13
Posted
transperineal and rectal are both prostate biopsies, just different points of entry into the body. what makes a difference is how the needles are guided. ultrasound gives you live imaging, but not as clearly as live MRI, or in-bore. MR images are more definitive as to areas of abnormal cells also, to instead of turning the prostate into swiss cheese, choosing sites to puncture according to an arbitrary grid, the live-action MR images tell the doctor where to puncture for the best chance of finding the cancer cells, so less punctures are needed. 12 holes vs. 4-5 -- less is better, in this case.
barney34567 libralady13
Posted
That is why I opted for the transperrineal.
rich22 barney34567
Posted
i didn't mean to imply that there's no difference between TRB and TPB. Transperineal biopsy would seem to be "cleaner" and recent concern for super-antibiotic-resistant bugs would preclude using the perineal route, i have not seen any studies comparing the two. i have read that tpb gives greater access to the entire prostate, esp. when using the grid instead of US- or MRI- guided needles, but the anesthetizing seems more complicated. i haven't decided on which i'll be having for my first biopsy in 3 weeks... or even IF i'll go through it at all. yes, sepsis and spread of cancer cells by the needle are rare, compared to the risk of NOT having a biopsy and histology-reported gleason score. but that'swhy i joined so many groups seeking "alternative treatments" - it's all so confusing at times. i'm getting more freaked out as the date approaches... probly shouldn't be commenting at all here.
libralady13
Posted
Sorry hope my post makes sense I can see some mistakes. I must read through them before posting. That's me always in a rush. I meant to say his prostate size has not reduced by half so I don't know how that relates to the finasteride.
barney34567 libralady13
Posted
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).
rich22 barney34567
Posted
i've read that PCa's affinity for choline makes the choline C-11 the better choice for PET CT than the Ga68
barney34567 rich22
Posted
I don't know what papers you read, but I give weight to independent bodies like the US National Institutes of Health more so than stand alone medical facilities. Unless those facilities are world leading.
I undergo PSMA PET CT scans very often and there isn't much on that that I have not read. In Jan 2017 the NIH published a study of 123 patients comparing 68Ga-PSMA and IIC-Choline and concluded that PSMA was better in detecting lymph nodes and bone lesions.
Just Google PSMA versus choline and the article will be near the top of the page.
rich22 barney34567
Posted
ya, just read this one, not sure it's the one you're referring to, but i'd have to concur that PSMA is more definitive.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439210/