Pirad 2 - How much of Concern?
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Am 68 and after PSA slowly ticking upward over the past 6 years from 3.9 to 4.0 to 4.5 to 4.8 and then from 5.5 to 6.0 I was diagnosed by a urologist with BPH; susequent TRUS biopsy was clear. Urologist provided another PSA which came in at 6.2. He then recommended a Uronav MRI.
Today I received the results, which I am waiting to review with the urologist at the beginning of May.
From what I can determine, I have received a grade of Pirad 2. What is normally recommended for this - watchful waiting following additional PSA tests - or is a biopsy often recommended?
Look forward to your opinions!
EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE WITHOUT AND WITH CONTRAST WITH CAD
HISTORY: 16-year-old with PSA level of 6.2 and previous benign biopsy
TECHNIQUE: Multiparametric MRI of the prostate gland was performed using T1 weighted large field of view images, small field-of-view T2 weighted images in the axial, coronal and sagittal planes, diffusion weighted imaging with B gradient values of 1000 and 1500, and dynamic postcontrast T1 weighted imaging using a 1.5 Tesla superconducting magnet. Multiple projections both prior to and following the intravenous administration of 20 cc of gadoterate meglumine from a 20 cc single-use vial were obtained. On a separate independent DynaCAD workstation, 3-D volume rendered reformatted images were generated with physician participation and monitoring. Images are evaluated and ADC maps as well as post contrast kinetic analysis is performed.
COMPARISON: None.
FINDINGS: The prostate gland measures 6.0 x 5.8 x 4.6 cm in craniocaudad, transverse and AP dimensions. The gland has a calculated volume of roughly 80 cc. The membranous urethra measures 14 mm.
There is nodularity and heterogeneity of the central gland with impression upon the bladder trigone consistent with benign prostatic hypertrophy.
Evaluation of the peripheral zone demonstrates mild signal heterogeneity without discrete focal mass, significant restricted diffusion or abnormal enhancement.
The neurovascular bundles are intact without evidence of mass.
The urinary bladder is intrinsically normal.
The seminal vesicles are symmetric without evidence of mass, abnormal enhancement, or hemorrhage.
There is no significant pelvic lymph node enlargement.
There is no ascites.
The bowel loops are unremarkable .
No suspicious skeletal lesions are observed. Incompletely imaged roughly 7 cm lipomatous tumor in the proximal right thigh.
IMPRESSION:
Evidence of benign prostatic hypertrophy with mild signal heterogeneity of the peripheral zone. No discrete focal mass, significant restricted diffusion or abnormal enhancement.
PIRADS 2: Clinically significant cancer is unlikely to be present.
PROSTATE IMAGING REPORTING AND DATA SYSTEM
PIRADS 1 = Clinically significant cancer is highly unlikely to be present.
PIRADS 2 = Clinically significant cancer is unlikely to be present.
PIRADS 3 = Clinically significant cancer is equivocal.
PIRADS 4 = Clinically significant cancer is likely to be present.
PIRADS 5 = Clinically significant cancer is highly likely to be present.
0 likes, 4 replies
Guest PJ2323
Posted
i had an MRI in Jan 2019 when i had PSA 7.1 and it noted Pirads 2. i had another one in July 21 when i had PSA 12.0 and it scored Pirads 4. So they did a biopsy with 12 cores taken and result was negative, no PCA found. so even if you get a higher Pirads than 2 it can turn out not to be PCA.
PJ2323 Guest
Edited
Thanks for the info. Am curious if you have ever been diagnosed as having BPH which I understand can also give rise to elevated PSA numbers. Also, what was the reason provided by your provider for such a sharp rise in PSA with a PIRAD 4 score but with no discovery of any PCA. I am naturally very happy for you regarding the outcome but find everything about this so mysterious!
Guest PJ2323
Posted
i had PSA of 8.6 in Jan 2013 and had an MRI which was Pirads 2 and diagnosed with BPH. it then hovered around 2-3 until Dec 2018 when i had a PSA of 7.1. again another MRI Pirads 2. Prostate had grown from 40-57 cc in that time. 5.95 in Apr 2019, 3.0 in Dec 2019, again in Dec 2020 then 12 in Dec 2022 which warranted MRI and Pirads 4. as stated prostate buopsy showed benign growth only. no reason for spike but as you can see for me it does so every few year for some reason.
barney34567 PJ2323
Posted
The key to interpreting a PIRADS score is to determine the reputation of the radiologist reporting. I was referred to a guy who has many years reporting only on PCa. That is, he is an expert.
He opined that my case was a PIRADS 4 and a biopsy and later surgery proved him right.
If the radiologist in your situation is an expert on PCa reporting, then a PIRADS 2 result is not something to worry about.