PI RADS score of 4

last year I had a pi-rads score of 3 with indications of a couple lesions in the intermediate Zone. neither of the two urologists I saw indicated that it meant a 60% chance of serious cancer, while you seem to indicate that a score of 4 is a 75% chance (well it would actually be 80%). my first urologist even declined to do a Fusion biopsy because he said the pi rads of 3 wasn't serious enough to Warrant it. my second opinion urologist said the fusion biopsy was warranted but it had been so long since the pi rads that he would want to do another one first before proceeding to a fusion biopsy. the first urologist indicated that he just wanted to do a regular blind biopsy without targeting the intermediate Zone at all which I thought was crazy. so I still haven't made the biopsy decision. my PSA a year-and-a-half ago was six then it went to 7 then it dropped to 3 then up to 5 where it is now. I'll admit that the chance of infection or sepsis is somewhat of a deterrent in my decision to get a biopsy.

my mistake if you were told a score of four meant 75%then my saying 80% was probably wrong and I did not read your comment closely enough. I was never told that my score of 3 meant anything particularly as far as probability of cancer.

I just had an MR Prostate WO Contrast. The report says under finding for the prostate measures 4.7 x 3.8 x 3.8 cm in size, with a total volume of 35 cc. 

Lesion 1: Size 0.8 x 0.8 0.8

T2 Score:4

DWI score :4

Also it says there is a suspicious right peripheral zone prostate nodule, with nonspecific short segment abutment of the capsule.

PI-RADS: 4 - High

I just saw the results on the EMR and I know my Urologist is going to want a biopsy which is fine once he gets this report, but I'm so anxious right now for information about this. Anything anyone that knows. Possibly cancer? And if so does it have stages like other cancers? 

 

Hi,im sorry to hear your news its terrible when dr comes back with some type of bad news i know what you are feeling i had a mri with contrast because when dr did his exam on me he said he felt something hard so when i did the mri it came back that i had a T2 pi rads 4 and pi rads 5 on periperal zone for 5 weeks my head was spinning out of control i did alot of reading that put me more anxious i had my exam and mri done here in miami at baptist cancer institute, ut then i went to see other dr , mark gonzalo at university of miami Sylvester center only because i read that you should take your mri to be inspected by a senior rx specialist and i did lowering my pi rads 4 to a 3 and 5 to a 4 i did my biopsy my advise is take xanax 2.5 strongest pill i took it 30 min before the biopsy i didnt feel nothing at at i mean nothing my sister is a dr and said take this better then valium, please take it will help you alot , im a chicken s**t , and with all the anxiety i had i was waiting for the worst, that never came , 1 week later after 16 biopsy samples they all came back negative thank god , and dr i did alot of praying drank alot of green mocha tea, ginger , and tumeric, for 1 month prior, and used organic molasses with bakeing soda 2 times a day before going to sleep and mid day please look it up on you tube. My psa was 2 and im 55 years old at the end my friend drink as much green stuff as possible with ginger and tumeric , and check out youtube about molases with bakeing soda, have lots of faith think positive, start with the greens vegetable in blender , dandillion

Spinch. ,Kale , with pomagrande blend it up with water drink it and stay away from sugers as much as possible, it will change the way you think about food but for the better and what ever the results hopeing for the best, there are treatments out there

You will probably die of other things and not this , but get second and 3 opinions before take any steps foward good luck god bless you but do change way of eating , we are all here to help you thru this you are not alone ,

It looks like you don't get it, or want to get it.  I'm done.  Good luck!

my urologist in Columbus Ohio was opposed to a a fusion biopsy regardless of my Pi Rads score of 3. at the Cleveland Clinic they did tell me that a fusion biopsy was indicated but it had been long enough that I needed another 3T MRI. making decisions is bad enough without two different urologists giving you two vastly Divergent opinions

I get my care at a VA medical center affiliated with a large well regarded medical school affiliated with an international cancer institute. I would suppose the MRI was read by a resident and confirmed by a specialist, I'm quite confident they have some of the best in the business involved.

  

It seems the PI RADS is pretty good at finding no cancer and eliminates the need for unnessary biopsy's but like most of the PCa diagnostic tools available today it is not very good at distinguishing between an agressive cancer that needs immediate treatment in most cases and one that is not aggressive. Hopefully in a few years it won't be such a crap shot.

In my particular circumstnces a biopsy dosen't make sense as it won't effect my ultimate treatment choice, I'll wait until I'm symptomatic before starting any form of threatment. I do think the transperennial approach sounds mych better than the TRUS biopsy. 

Not only are there many divergant opinions  and treatments out there the fact is that every individual reacts differently to the prospect of PCa..some say its they way you are wired. For me, I value quality of life in the next few years far than any extension of life span which will do me no good anyway...

I would agree that another 3T MRI may be warranted before a biopsy if say 6 month have elapsed since the last 3T MRI which was suspicious for PCa.

I agree 100% with your sentiment to prioritise quality of life ahead of longevity with a low quality of life.

But I disagree with your comment that everyone reacts differently to PCa. The key is to identify if you have a high or a low grade PCa. There is no guaranty that even a high grade cancer will spread very quickly. What the literature shows is that the higher the Gleason score, the greater the propensity for the PCa to spread.

I would not waste time or money with another 3T MRI if the last one was performed in the last few months.

I would go ahead with an ultrasound guided fusion transperenial biopsy to clarify the picture ASAP with a PIRADS 4.

If however you insist on nor racing ahead with a biopsy then I humbly suggest you get a PSMA PET CT scan. This will show where the PCa throughout your body and will be useful for you to get a handle on the question as to whether the PCa has speead beyond the prostate.

Hi just reading this thread 

Just had an MRI scan of the prostate. At follow up consultant casually said I’m surprised you are PI-RAD 5 with such a low PSA! Didn’t have a clue what that meant just remembered it so I could google it afterwards! He didn’t seem at all concerned so at the time neither was I? I’m booked in next week for a MRI Fusion Transperineal Targrted Biopsy Oct 5th 2017! After reading the likely hood of this being clinically significant cancer (or am I getting mixed up with Gleason Scale?) should I be worried or is it common the PI-Rad 5 can mean nothing at all? Any advice please. I’m not scared just need to do what’s best! I’m 50 years old! Is that young? 

Hi, sorry for my late reply but I was unwell and not checking emails etc. The key to a prostate MRI is to have it reported on by a specialist in prostatic images and not just a regular radiologist. Was your scan reported on by a specialist in prostate images?

 

 

I should add two things.

1. PIRADS is a very good guide to what's going on. If the images were reported on by a specialist in prostate images then you most likely have PCa. And your decision to get a transperennial u/s guided biopsy is good. At 51 I had a PIRADS 4 revealed in a MRI and then had the same biopsy you are having.

2. The comment on low PSA by the consultant shows that he knows diddly squat. All world class urologists know that the PSA number itself, high or low, is irrelevant. What is relevant is the change over time in the PSA. Regardless of the number, if it doubled in less than a year then cancer  should be staringky considered. Taken with the PIRADS results, I think the biopsy you will have is the best diagnostic tool there is .

Good luck.

Thank your for your reply! Hope you are feeling better. From what I understand the radiologist who reported on this was fully trained to read these scans, as there was a delay in reporting on this due to radiologist being on Leave and the other radiologists weren’t able to report on it. So I can only assume the delay was to allow for a more accurate reading by the most suitably qualified. Like you say I’m doing the best thing by having the MR Fusion Transperineal targeted Biopsy. I’ll know next week either way! Again thank you for taking the time to respond! 

Cheers

Michael 

Hi again. Just to ease your fears, I was ill with a nasty cold. Nothing whatsoever to do with PCa.

I suspect your urological surgeon will give you antibiotics to take 1-2 days before the biopsy. And I think for a few days later.

Hopefully you will be in the clear with the biopsy. If not, then at least you will be very well armed with all the facts as to the stage of your disease. And don't forget, you can come in here to ask questions at any time.

This place is full of those, like me, who have been where you are and can share tips on what to expect etc.

Good luck.

Wow 

Thank you Barney for your advice, kind words and well wishes! Glad you’re well. I will be back to ask questions next week and let you know the outcome too! 

Cheers 

Michael 

Yes im having anti biotics orally on the day and IV throughout the procedure! Started on Tamsulosin (flowmax) tonight to reduced prostate swelling! Deep joy! My consultant urologist is one of the best in his field. I feel in good hands and I’m remaining positive! Is it painful post procedure, I’ve not booked anytime off work afterwards so planning to go into work the following day. What do you think about that! 

Sorry for the late reply, but I am having difficulties accessing the forum for reasons unknown.

You ask if the procedure is painful.

The procedure is not a walk in the park. It is invasive and, In my case, required general anaesthesia (with all the risks that come with that).

But saying that, I had no pain post-biopsy that could not be managed well by meds. And the pain lasted a couple of days at the most.

Don't be shocked if, for a few days afterwards you feel tender sitting down and your urine will go red.

Thanks my friend. Well wish me luck. It's happening today and I'm having a general so all good there! 

Cheers Barney

Regards Michael 🤞

Well you were right Barney, my urine is quite frank blood in colour at the start of each pee then runs clearish towards the end! Oh yes it is tender to sit but otherwise no real pain that simple anagesia can’t control. Now the waiting game! Hope it’s all good! 

Hello Michael,

Stressed spouse here.  Hubby just had MRI with PIRAD 4 result.  Consult for biopsy is scheduled.  Question for you if you don't mind.....I think that a rectal approach is planned for him, however I feel from what I have read and from my limited knowledge the perineal approach seems to make more sense in that it is "cleaner" and also more accurate in getting to the right spot.  Do we push for that type of biopsy?

Can you tell me about the recovery?  And what happens next?

Many thanks,

cj

My advice would be to push for the transperineal biopsy if it's available in your area, even if your urologist pulls a long face on you. It seems rather difficult to get in the USA while it's quite common in Europe in Australia.

Hi ,wanted to know what was your final result, god bless you

My final result is all very reassuring despite my initial scare. There are many people on here who argue about the unnessary invasive procedures after an imaging results high up the scales and my experience would agree with that. However having the Fusion Targeted Trasperinneal biopsy come back negative that's the most conclusive results. Still doesn't explain my high Pirads and elevated PSA! That's where the confusion starts for many of us. Good luck for the 15th  

Dies the dr have an idea of what else can give you a pirad 5 and in my case my psa is 2

Sorry it was does , not die,,, my bad , does the dr have any idea what can cause a pirad 5 what else can cause this like your mri but then come back negative on biopsy,like i said my psa is 2 im 55 , but mri reading was a suspicious pirad 5 and 4 lradiologist said an impression, on that , dr said to me till you dont get that biopsy. Nothing is for sure.what i have seen on internet is it all depends what experience they have with these mri these radiologist , im scared of my pants , well thank you , keep in touch

Don't be scared remember this is mostly treatable, yes the urologist said pirads can be easily misinterpreted by the radiologist, which is something that needs to be addressed urgently in my opinion. Also he believed my high pirads to be caused by benign inflammation of infection. Especially as biopsy was clear. You'll be fine my friend, I'm sure! Kep me posted 

Thank you. I will keep you posted, and as well will pray for you my friend

Hello my friend, just wanted to tell you i did fusion biopsy on the june 15 , i didnt feel a thing my sister is my primary dr, she prescribed xanas 2.5 strongest one out there i recommend any body doing this to take it i was scared of the biopsy i was reading so many man that said pain was terrible i was scared to death. At one point i was going to get general but as well there was more consequences to that, at the end just did what i told you took pill 30 min before the procedure, knocked out cant remember nothing, i did it here at university of miamiwith a great dr gonzalo considered one of the best in the west coast now here on the east coast in florida, like i said he called me , said everything was great they found nothing , thank god no inflammation or cancer , they took 16 samples , he said thats why i told you mri are not 100 percent , im happy and i will make other mens aware to do what they need , to check them self , and post as much as posdible to help other on there treatment to give peace to other men just like you gave it to me i thank you for y post and god helped me find your post to give me at least some type of peace till my biopsy came back , i thank you again and may god bless you and i hope you stay healthy. For the rest of your life at least from this big stress to so many mens out there ,

Sorry if my english is not great im from cuba, but i try

Wow. That is very good news.

By the way, your English is just fine.