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The ever growing Prostate and PIRADS scores

User
Posted 03 Oct 2021 at 17:46

Hi,

As part of my ongoing prostate “journey” I’ll be having an 3T MRI next week, so I’ve just pulled out my expansive file from 2016 when all my shenanigans started....I note that in July 2016 I had my first MRI which prompted 2 biopsies (Trus & TP both clean) First MRI report showed small PIRADS4 lesion, left apex ...Prostate volume 50cc

Because of the clear biopsies I was followed up a year later in July 2017 and this time the MRI report was PIRADS 3 lesion, left apex....Prostate volume 70cc

This kind of passed me by at the time (all the time the Doc wasn’t using the “C” word I wasn’t really tuned in....Just wanted to ask if anyone had ever had a PIRADS score that lowered with time (Is it objective depending on the radiographer)? And also, does anybody consider a 20cc prostate growth spurt in a year a tad suspicious?

Thanks in advance 

Tony

 

User
Posted 05 Oct 2021 at 13:05
Hi Tony

Yes, I've had a PIRADS score that's decreased over the last 3 years, I think it depends on the radiologist.

PSA test in October 2018 was 3.2, sent for a MRI scan in Worcester which showed lesion with PI RADS score of 4. Fusion Target Biopsy took 17 cores which were all benign.

PSA increased to 4.2, MRI with contrast in a 3T scanner in London booked for 18th October 2019 - PI RADS score is now 3 (reduced from 4), new consultant wants 6 monthly PSA tests with the possibility of a template biopsy if there is a significant increase.

February 2020 - PSA decreased to 3.4

August 2020 - PSA back to 4.2

MRI with contrast in Birmingham in October 2020, PIRADS score now back to 3/4. Waiting on the next PSA test in February 2021.

December 2020 - started to experience gross hematuria in initial urine stream, suspected bladder cancer but after a cystoscopy in February 2021 bleeding was found to come from prostate. PSA now 4.4

August 2021 - PSA down to 4.2

September 2021 - MRI with contrast in a 3T scanner in London, results a week later - no sign of any lesion on my prostate (amazing after a PI RADS of 4 in 2018). Consultant has discharged me with a requirement for a yearly PSA test.

User
Posted 03 Oct 2021 at 21:07

The report is definitely subjective. I have seen my MRI scans, of course I have no knowledge in interpreting such things, but I can say they are somewhat fuzzy. Imagine taking a photo of a walnut with an out of focus camera and then guessing the volume of the walnut. Two people will come up with different answers. Whether 40% or not I don't know, but a 10% error in a linear dimension is a 30% error in volume so it sounds within the realms of possibility to me.

There are a few articles about biopsy "gleason grade inflation" which suggests that biopsy results are also subjective. 

We have mentioned on this forum that psa tests are not reliably comparable unless done at the same lab. I would say the same is probably true of MRI reports. Both sets of you MRI images probably still exist so if you asked for a second opinion you may be able to get them all interpretted by the same radiologist and get a more reliable history of your prostate. 

 

Dave

User
Posted 05 Oct 2021 at 16:08

Depending on the results of your 3T hi-resolution MP-MRI scan, I think you can look forward to another transperineal biopsy.

Although I’m sure it’s disconcerting, it must be nice to keep being told you haven’t got prostate cancer - maybe you are a medical enigma, like me?

I have had a chronic productive cough for over a year, and despite a chest X-ray, sputum and blood tests, CT scan, an hour-long lung evaluation in a telephone box connected to computer screens where they fed me carbon monoxide, oxygen and carbon dioxide via a snorkel-like mouthpiece, and a second CT scan, two telephone conversations with the consultant, they still don’t know what’s wrong with me.

During the whole process, no doctor has put a stethoscope on my chest, presumably down to Plague Panic Paranoia, which pervades our Covid Health Service.

Best of luck.

Cheers, John.

Edited by member 06 Oct 2021 at 01:59  | Reason: Not specified

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User
Posted 03 Oct 2021 at 21:07

The report is definitely subjective. I have seen my MRI scans, of course I have no knowledge in interpreting such things, but I can say they are somewhat fuzzy. Imagine taking a photo of a walnut with an out of focus camera and then guessing the volume of the walnut. Two people will come up with different answers. Whether 40% or not I don't know, but a 10% error in a linear dimension is a 30% error in volume so it sounds within the realms of possibility to me.

There are a few articles about biopsy "gleason grade inflation" which suggests that biopsy results are also subjective. 

We have mentioned on this forum that psa tests are not reliably comparable unless done at the same lab. I would say the same is probably true of MRI reports. Both sets of you MRI images probably still exist so if you asked for a second opinion you may be able to get them all interpretted by the same radiologist and get a more reliable history of your prostate. 

 

Dave

User
Posted 05 Oct 2021 at 13:05
Hi Tony

Yes, I've had a PIRADS score that's decreased over the last 3 years, I think it depends on the radiologist.

PSA test in October 2018 was 3.2, sent for a MRI scan in Worcester which showed lesion with PI RADS score of 4. Fusion Target Biopsy took 17 cores which were all benign.

PSA increased to 4.2, MRI with contrast in a 3T scanner in London booked for 18th October 2019 - PI RADS score is now 3 (reduced from 4), new consultant wants 6 monthly PSA tests with the possibility of a template biopsy if there is a significant increase.

February 2020 - PSA decreased to 3.4

August 2020 - PSA back to 4.2

MRI with contrast in Birmingham in October 2020, PIRADS score now back to 3/4. Waiting on the next PSA test in February 2021.

December 2020 - started to experience gross hematuria in initial urine stream, suspected bladder cancer but after a cystoscopy in February 2021 bleeding was found to come from prostate. PSA now 4.4

August 2021 - PSA down to 4.2

September 2021 - MRI with contrast in a 3T scanner in London, results a week later - no sign of any lesion on my prostate (amazing after a PI RADS of 4 in 2018). Consultant has discharged me with a requirement for a yearly PSA test.

User
Posted 05 Oct 2021 at 14:52

Hi Morpheus,

 Thanks for replying.....Good to hear you’re doing OK. Hopefully it’ll stay that way for good...Amazing to think that a PIRADS 4 can just disappear....Like you say it depends on the scan, the radiologist and if they’ve wiped a cloth over the screen I suppose. I foolishly let my PSA rise the last couple of years (3.0 in 2017 and then last October 4.8) because my Uro said that given the size of my prostate he’d only worry if the PSA went over 10....This year a reading of 8.4.....then 5 weeks later 14.8, that was 5 weeks ago, I’m terrified to think it might still be rocketing upwards....Plus in the last 6 weeks I’ve developed some dull back and groin pain.....Which is likewise freaking me out...just had the MRI....appointment with Doc next week...I’ve already picked out a headstone 

 regards

   Tony

User
Posted 05 Oct 2021 at 16:08

Depending on the results of your 3T hi-resolution MP-MRI scan, I think you can look forward to another transperineal biopsy.

Although I’m sure it’s disconcerting, it must be nice to keep being told you haven’t got prostate cancer - maybe you are a medical enigma, like me?

I have had a chronic productive cough for over a year, and despite a chest X-ray, sputum and blood tests, CT scan, an hour-long lung evaluation in a telephone box connected to computer screens where they fed me carbon monoxide, oxygen and carbon dioxide via a snorkel-like mouthpiece, and a second CT scan, two telephone conversations with the consultant, they still don’t know what’s wrong with me.

During the whole process, no doctor has put a stethoscope on my chest, presumably down to Plague Panic Paranoia, which pervades our Covid Health Service.

Best of luck.

Cheers, John.

Edited by member 06 Oct 2021 at 01:59  | Reason: Not specified

User
Posted 05 Oct 2021 at 18:20

Hi John,

your experience of the telephone box sounds mighty interesting. Did they ask you to press button B? (One for the teenagers). To be fair to the NHS my Doc referred me immediately when I got my high PSA reading in August. I held them off 2 weeks as I was going to a wedding in Cornwall. Had my MRI on Sunday. The 2 guys doing the procedure lacked a certain bedside manner but maybe they didn’t want to be working Sundays....I now have a meeting with somebody next Thursday. I’m hoping it’s the man in charge but I won’t hold my breath....I’m guessing a biopsy is on the cards. My main concern that if it is cancer it should/could have been caught a few years back. Looking back at my notes I see that my PSA jumped from 3 to 3.7 in 6 months and my Uro wasn’t concerned. My PSA of 14.8 will be nearly 2 months old by the time I get to see the Doc ....Que sera, sera I guess

regards Tony

 
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