Second opinion for my MRI results

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Hi.My name is Tiberiu and I am from Romania. I am worried so I would like to know your opinions about my MRI results, please!

I am 57 years old. I have no signs, symptoms or any pain.

My PSA is 4ng/ml.

DRE result:

enlarged prostate, increased consistency in right lobe.

MRI result:

Slightly enlarged prostate ( 3.5\ 5.6\ 4.9 cm), no nodular gadophilic lesions evident on MRI, with slightly restricted diffusion, in the central lobe, with non-homogeneous, geographic pattern. PIRADS code= 3.

Follow-up MRI is recommended.

VU, seminal vesicles, large vessels, rectal lochia, bony structures, intra- and extrapelvic soft parts without obvious pathological changes.

No notable adenopathy, no intrapelvic ascites fluid.

Conclusion:

PIRADS prostatic hypertrophy = 3. Follow-up MRI is recommended.

My urologist recommend biopsy.

I don't know what to do! I would rather avoid the biopsy.

According to the MRI there is an abnormality in the center lobe and according to the DRE there is an abnormality in the right lobe.

Do I need a biopsy or is it sufficient, as recommended in the radiologist's conclusion, just follow-up MRI?

Thank you in advance.

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14 Replies

  • Edited

    What you need is to have a radiologist who specialises in reading prostate images to report on your images.

    Someone who is not an expert can misread images and give the wrong conclusion.

    This is especially so in your case given you are said to have PIRADS 3. This result is inconclusive. You may or may not have PCa (cancer). If you have it, it may not be so bad that you need treatment.

    In answer to your specific question on biopsy: I suggest "NO RUSH".

    Assuming the radiologist who reported on your MRI is not an expert, spend time looking for someone who is an expert and will be happy to report on it to you.

    This may be a radiologist in another hospital in Romania or even in another country.

    If you find someone, he will expect you send him/her your images on a disk.

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    • Posted

      Wow, thanks for the quick response. I will definitely seek a second opinion from a radiologist specializing in urological problems for a more accurate interpretation of MRI results.

      What made me confused is the fact that, although the urologist who consulted me and did DRE found an abnormality in my right lobe, no node appears on the MRI results, only a slight restriction of diffusion in the central lobe (lob which in most cases is correlated with benign prostatic hyperplasia).

      As for the biopsy, like you said, I'm in no hurry. I read that 93.5% of the biopsied PIRADS 3 lesions are benign and 6.5% of these lesions are found on histological analysis to be prostatic cancer.

      Thanks once again and I'll keep in touch with you.

      Have a great day!

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    • Posted

      Glad to help.

      As to DRE, my Australian urologist and a few others do not believe in it one bit. It is often used to decide if a scan should be performed. As you have had a scan, what is needed is a smart fellow to report on it. What one doctor thinks he feels in a DRE is not important when a scan has already been performed.

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    • Posted

      Me too, G9, but I had an expert report on the images and he was sure of PIRADS 4.

      The question in your case is: did an expert report on the images or was it a generalist radiologist?

      How has your treatment gone so far?

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    • Posted

      Hi Barney,

      It is so hard to find a radiologist here who is specialized in urology. I sent the MRI CD with all the necessary documentation to 2 different hospitals in Turkey, but for nothing. I got only one short answer: to have a multiparametric MRI. I realized that they didn't even open the archive where I sent the CD with the scans. I don't know where else to send it.

      Do you think you could help me, give me any suggestions or an email address where I could ask for such an interpretation?

      I'm sorry to be so rude, but I'm a little worried and I don't know what to do.

      P.S. Sorry for my poor english, hope you understand me.

      All the best

      Tiby

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    • Posted

      Hi again,

      A few things come to mind:

      1. Yes, multiparametric MRI (using 3T scanner) is the best MRI to do
      2. If you are happy with the quality of urological treatment in Turkey, say Istanbul, then Google for

        prostate surgery or

        prostate MRI

      and hopefully you'll find the name of a radiologist or surgeon who could assist.

      I really cannot assist as I like most people in here are patients not doctors.

      1. If you want say a Western doctor's opinion, you could search online for say

        prostate surgery or

        prostate MRI

      in say Germany, Netherlands or UK

      In that case, after you find the name of an expert, ask if they could offer a second opinion. You do not have to visit them, you will need to send them your disk. Often these doctors charge a fee, but it is worth it for piece of mind.

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    • Posted

      I too am in Australia and had some treatment (for another disease) in the US.

      The problem I found is that there are many "bests" in Australia. Unlike the US, there is no objective list of who has done what and for how long and what their reputations are like.

      In the US I found there are lists, so one can really find who is good and who has not performed as well as they think they have.

      Great to hear you're doing well. Me too.

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    • Posted

      good one Barney,

      re MRI, Its a 2nd line screening tool and you are PIRADS 3 which equals equivicol, which is still going to occur on occasions no matter who reads it, would make sense to go to the next line of screening which is the biopsy. Not what I did, but it could've cost me my life for not doing so

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    • Posted

      I see. So you were PIRADS 3 (which I agree is inconclusive) and then G9.

      I was PIRADS 4 and then G9.

      Of course the biopsy is the one thing that gives a good indication of what the situation is. Far better than a PIRADS reading.

      That said, a pre-op biopsy (no matter how good) can still differ from a biopsy performed after surgery, when looking at the tissue.

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    • Posted

      Hi, Barney,

      I come with some news. I repeated the PSA. This time is 2,15 . I forgot to tell you that my first PSA value ( 4,0 1) was after an antibiotics treatment for prostatitis. I was looking for an second opinion and the other urologist told me to cancel the biopsy for now and repeat my PSA in 3 months again. If it stays the same like now ( 2,15) and according my IRM rezults , it's probably a benign BPH.

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    • Posted

      Antibiotics seems to have lowered your PSA. That is good. In my case they did not, which led to the diagnosis of cancer.

      I agree 100% to wait 3 mths and redo the PSA at the same facility you recorded 2.15, as labs differ in their measurement protocols.

      If it stays the same, then redo the PSA 3 mths later.

      The indication for cancer is a rising PSA over time.

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  • Edited

    I'm not a doctor. I'm not sure a doctor would comment in an online forum like this for fear of a potential law suit (I'm a lawyer). But speaking now as just a guy, and one who has had a couple of prostate biopsies in his 58 years, my thought is to do it. It's not that bad. Prostate cancer is not something to mess with. I'd want to get checked and come away with a clean bill of health or specific treatment options.

    The first time I had a biopsy, my urologist wasn't all that competent. He didn't get enough samples and it was uncomfortable. When I had it redone, I first found a better urologist. He provided a medicine to relax me and I was very comfortable. Had to have someone there to drive me home. He got the right number of samples.

    Recovery was pain free. Really the only challenge was the biopsy itself. Oh, and don't have sex too soon after. Made the mistake of getting frisky with my then girlfriend too soon after the procedure and the climax was painful (seriously painful) and messy (a lot of blood). Fortunately I had withdrawn but not pleasant for either of us.

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