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PIRADS 5 Low PSA

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User
Posted 21 Mar 2021 at 08:49

Hi, my husband had just recently suffered a heart attack and is on blood thinners and aspirin etc. Complaining of abdominal pain and doctor discovered that his prostate was slightly enlarged, she couldn’t feel around the back of it and referred him to Urologist. His PSA came back 0.8 and his bloods were good. We paid for a private abdominal scan which showed a fatty liver and a slightly enlarged prostate., everything else was normal. The margins of the prostate were 3.4cm x 3.4cm x4.0 cm. Spoke to Urologist on phone who wanted to do an MRI to be on safe side as my husband’s sister died of breast cancer and his uncle has had prostate cancer. Urologist phoned today to say that MRI (not mpMRI) showed a 17mm lesion rated PIRADS 5 on left side and he wants my husband to come in for a biopsy. The measurements that MRI is that the prostate is 3.5mmx3.7x4.0mm. Can lesion have grown so quickly in 6 weeks? Cardio team do not want him to have biopsy at moment as it would involve coming off blood thinners for 10 days. I’m very worried for him. I’m worried that as lesion is larger and PSA is so low that his cancer will fall into the aggressive category. Has anyone had any similar experiences? Thanks you in advance.

User
Posted 21 Mar 2021 at 20:30
Believe me, the anticipation of the biopsy is way worse than the event itself. It's undignified and uncomfortable, but relatively painless.

Best wishes,

Chris
User
Posted 21 Mar 2021 at 17:20

Originally Posted by: Online Community Member


Thank you for taking the time to reply to me John. 



No problem, anytime, as with everyone else here.


Get on the case with that urologist / cardiologist conversation.


Cheers, John.

User
Posted 21 Mar 2021 at 19:30

Yes the waiting is horrible. Ask any questions in the mean time, and when you do get the results let us know. That is how we build up knowledge on this forum and can go on to help others. 

Dave

User
Posted 22 Mar 2021 at 02:14

The reason I am against TRUS biopsies is that when I had to have a biopsy, two friends told me they had had a TRUS but then had to have a further transperineal biopsy subsequently. So I eschewed a TRUS and waited for a transperineal test instead. I still had cancer....☹️When I was on the ward after my biopsy, the guy in the opposite bed said the same, buy one get one free.


Since I became involved with this site, I have read of numerous men who have had this same ‘buy one, get one free’ problem. I think the record is three TRUS biopsies before finally having a transperineal biopsy.


In your Old Man’s case, there may be a big enough mass to aim at via TRUS. Anything inconclusive could result in further testing. Let’s hope you get a definitive answer first time.


In the words of the leading prostate cancer oncologist at the world famous Royal Marsden cancer hospital: “The.......trial has shown us that the TRUS biopsy is as bad as we thought it was”.


Yes, it’s all about the waiting isn’t it? Be prepared to wait some more as biopsy results don’t arrive the next day. My post-op biopsy samples (obviously non-urgent) were in a freezer in Guildford for about three weeks before being checked as the pathology lab was short staffed.


I hope you get some answers as soon as...


Cheers, John.

Edited by member 23 Mar 2021 at 01:54  | Reason: Not specified

User
Posted 21 Apr 2021 at 17:33

Hi there, just an update on my hubby’s situation. Having been told that his lesion was rated PIRADS 5, he had a meeting with a consultant today to be told that his lesion is benign. His PSA will be checked in a few months and he will be rescanned in a year. But so far so good. I’d like to thank you all for your support and I wish everyone well. Many thanks. 

User
Posted 21 Apr 2021 at 18:05

Wonderful news, that is now four people we have had on this site recently with a Pirads5 that has turned out not to be cancer. Obviously keep an eye on things, but you can now relax.

Dave

User
Posted 21 Apr 2021 at 18:18
Excellent news 😁

Best wishes to you both,

Chris
User
Posted 22 Apr 2021 at 19:29

Great news, happy for you 

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User
Posted 21 Mar 2021 at 12:26
If he has got any cancer, most prostate cancers are slow growing, so a few weeks or months post his cardiology event before a biopsy is probably neither here or there.

The PIRADS result shows a lump which may or not be cancerous, so a biopsy will be necessary at some point for a definite diagnosis. Don’t let him be palmed off with an often inaccurate rectal (TRUS) biopsy, which as well is sometimes inconclusive, go for a transperineal biopsy instead, where more samples can be taken.

I had no bleeding except for my first couple of pink wees after the biopsy, but I did have a giant bruised perineum afterwards.

I would ask the urologist to discuss the implications of a biopsy with his cardiologist. There is not really any surgery in the biopsy to cause bleeding, just some sample needles inserted. I had 42.

If you have private health insurance, all well and good, but there is no need to keep paying if not, as with a suspicion of cancer he should be enrolled on the NHS fast-track cancer 14 day treatment plan, with other deadlines subsequently.

Best of luck.

Cheers, John.
User
Posted 21 Mar 2021 at 12:29

I am certainly no expert, but we have recently had three people on here with pirads5 who were given the all clear, of course we have had a several others who have had cancer, but pirads5 is not guaranteed cancer and the low psa is reassuring. The change in size of prostate is more likely to do with the quality of the scan and the interpretation of the image. The images are not very clear, and if you gave two people a walnut, a slightly out of focus camera and a ruler and said take a photo of that walnut and tell me what size it is you would get as much variation as per your scans.


I don't know if a dna test for the BRCA gene would be possible, if it is present then that may tip the balance towards investigating earlier, and if absent maybe tip the balance towards waiting until he is more stable. 


Having said all the above there are rare prostate cancer which produce low psa, so it can't be ruled out. Remember I'm just a lay person who has picked up information from this site, only the doctors can give you the best advice as what to do. 

Dave

User
Posted 21 Mar 2021 at 12:34

Thank you for taking the time to reply to me, you have given me hope. 👍

Edited by member 21 Mar 2021 at 12:35  | Reason: Incorrect name on post

User
Posted 21 Mar 2021 at 12:36

Thank you for taking the time to reply to me John. 

User
Posted 21 Mar 2021 at 17:20

Originally Posted by: Online Community Member


Thank you for taking the time to reply to me John. 



No problem, anytime, as with everyone else here.


Get on the case with that urologist / cardiologist conversation.


Cheers, John.

User
Posted 21 Mar 2021 at 17:22
If not an mpMRI then it must have been at least duo-parametric as a normal mRI would not have produced a PIRADS score, so from the sound of it, the MRI to his prostate was more detailed than the abdominal one done previously. As stated above, it is unlikely that the prostate changed size in that short time so just better quality scan and personal interpretation.

Also as stated above, PIRADS 5 just means it is highly indicative of cancer - 3 recent members have subsequently had the all clear following a biopsy on PIRADS 5.

I think Bollinge's comment about the different types of biopsy is a little out of date. Some hospitals have stopped offering template perineal biopsies now (particularly in areas where it is done under general anaesthetic) while others never started. In your husband's case, a template biopsy may be ruled out anyway because of his heart attack and the hospital may be doing image guided biopsies. Even if they decide that a TRUS is the safest option, don't let that concern you; they know where the lesion is that they want to sample which means the problem that Bollinge is referring to is not relevant in your case.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 Mar 2021 at 18:36

Thank you. It is a TRUS biopsy that will hopefully be carried out 1 April. The waiting is the worst part! 10 days or so until biopsy and then the two weeks waiting for results. But hey ho it’s the well trodden path that most of you have already been down. Thanks again. 

User
Posted 21 Mar 2021 at 19:30

Yes the waiting is horrible. Ask any questions in the mean time, and when you do get the results let us know. That is how we build up knowledge on this forum and can go on to help others. 

Dave

User
Posted 21 Mar 2021 at 20:30
Believe me, the anticipation of the biopsy is way worse than the event itself. It's undignified and uncomfortable, but relatively painless.

Best wishes,

Chris
User
Posted 22 Mar 2021 at 02:14

The reason I am against TRUS biopsies is that when I had to have a biopsy, two friends told me they had had a TRUS but then had to have a further transperineal biopsy subsequently. So I eschewed a TRUS and waited for a transperineal test instead. I still had cancer....☹️When I was on the ward after my biopsy, the guy in the opposite bed said the same, buy one get one free.


Since I became involved with this site, I have read of numerous men who have had this same ‘buy one, get one free’ problem. I think the record is three TRUS biopsies before finally having a transperineal biopsy.


In your Old Man’s case, there may be a big enough mass to aim at via TRUS. Anything inconclusive could result in further testing. Let’s hope you get a definitive answer first time.


In the words of the leading prostate cancer oncologist at the world famous Royal Marsden cancer hospital: “The.......trial has shown us that the TRUS biopsy is as bad as we thought it was”.


Yes, it’s all about the waiting isn’t it? Be prepared to wait some more as biopsy results don’t arrive the next day. My post-op biopsy samples (obviously non-urgent) were in a freezer in Guildford for about three weeks before being checked as the pathology lab was short staffed.


I hope you get some answers as soon as...


Cheers, John.

Edited by member 23 Mar 2021 at 01:54  | Reason: Not specified

User
Posted 27 Mar 2021 at 13:10

Hi again, my hubby has the ok for his biopsy which is scheduled for Thursday. When the consultant spoke to him, there was no mention of staging etc. Do you think it’s worth asking the radiologist on Thursday for those details or is it better to wait until results day. Will the the radiologist even be willing to discuss this with my husband? Not sure if urologist deliberately didn’t provide too many details because it may be bad news. Than you all for your help. 

User
Posted 27 Mar 2021 at 13:50
There is no staging until all diagnostic tests have been done and discussed by the multi-disciplinary team. All the radiologist can do at the moment is give a prediction of what might be found.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 27 Mar 2021 at 13:57

Hi thank you for replying. I think I may have misunderstood the phrase staging or misunderstood what the mri shows. I thought it could tell if the Pc (if that’s what it is) has moved outside of prostate to nodes etc. Mind is whirring constantly. I just keep thinking that a 17mm is going to have moved outside because of its size. Thank. 

User
Posted 27 Mar 2021 at 15:10
Yes your imagination is running wild. A 17mm lesion isn't a lump of tumour - prostate cancer doesn't act like that. The 17mm is an area of concern where they suspect the cells are abnormal. They might be able to see on the scan that what looks abnormal is also very close to or appears to have broken through the outer edge of the gland but they can't be sure until they have got the biopsies of the area. As I think a couple of us have posted already, we have had 3 new members on here very recently who were given PIRADS 5 but went on to get the all clear. The radiologist can suspect or be almost certain but no more than that.

The other thing to get your head around is that prostate cancer doesn't have a neat development plan. It doesn't go from 'contained' to 'broken through' to 'moved into lymph nodes' to 'bone mets' to 'lung' to 'soft organs'. It could be fully contained in the prostate but also in the bones, for example. Best to wait until all results are in.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 27 Mar 2021 at 15:13

Thank you for replying! I think I need to give myself a talking to!! You’re all so kind and I really appreciate being able to ask questions. Many thanks. 

User
Posted 27 Mar 2021 at 15:31

Originally Posted by: Online Community Member


Do you think it’s worth asking the radiologist on Thursday for those details or is it better to wait until results day.



I don't know how much the radiologist can see 'live' or how much is interpreted afterwards. As Lyn says only a biopsy is definitive. I think it would be a little unfair to ask the radiologist for information on the day, they just take the photographs they may be able to see things, but they may not want to talk about what they have seen. When I was told my results, there was an oncologist and a support nurse present. I didn't need much support, but I might have. 

Dave

User
Posted 27 Mar 2021 at 15:43
You’re right Dave. I’ve just let my mind work overtime on something I have no clue about. Best leave it to the professionals. Thanks again.
User
Posted 21 Apr 2021 at 17:33

Hi there, just an update on my hubby’s situation. Having been told that his lesion was rated PIRADS 5, he had a meeting with a consultant today to be told that his lesion is benign. His PSA will be checked in a few months and he will be rescanned in a year. But so far so good. I’d like to thank you all for your support and I wish everyone well. Many thanks. 

User
Posted 21 Apr 2021 at 18:05

Wonderful news, that is now four people we have had on this site recently with a Pirads5 that has turned out not to be cancer. Obviously keep an eye on things, but you can now relax.

Dave

User
Posted 21 Apr 2021 at 18:18
Excellent news 😁

Best wishes to you both,

Chris
User
Posted 22 Apr 2021 at 19:29

Great news, happy for you 

 
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