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Second opinion for MRI results

User
Posted 17 Nov 2021 at 19:55

Hi.My name is Tiberiu and I am from Romania. I am a little bit 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? 

Thanks in advance!

User
Posted 17 Nov 2021 at 22:41

You have had two differing opinions from professionals who have had the benefit of seeing your scans and examining you. As Lay people we are not in a position to tell you what you should do. We don't even know how long it would be before it is recommended before you have the next proposed MRI and whether this or the present one will be/was a multiparametric one. Would the proposed biopsy be a TRUS type or a Transperinal one? I feel you need to get further information from your consultants to help you decide how urgent a biopsy is.

Edited by member 17 Nov 2021 at 22:42  | Reason: Not specified

Barry
User
Posted 18 Nov 2021 at 02:18

Tiberiu, while your psa is not extreme, your PIRADS CODE = 3 is a bit of a worry.

Some research results here:

PIRADS lesions

So far, your DRE and MRI results are inconclusive so you certainly need to know more to decide what to do next.

MRI scans are limited in what they can detect, though a PSMA PET scan, using radioactive dye, will give you much more information than a "standard" MRI scan.

I can understand why you aren't keen on the idea of a biopsy but because they actually take cells from your prostate they can be analyzed and will give a detailed idea of whether you have cancerous cells present.

There are different types of biopsy as Barry says, so you could ask your urologist if you have a choice.

What you do next depends very much on putting together a more detailed picture of the state of your prostate.

Like you, I had no symptoms or pain but a biopsy indicated my Gleason score was 9 so I was very glad to have taken action when I did. Another year and I could have been in serious trouble.

 

Jules

 

Edited by member 18 Nov 2021 at 04:30  | Reason: Not specified

User
Posted 18 Nov 2021 at 03:21
Just go for the biopsy and don’t delay it, so you get a definitive answer. Avoid a trans-rectal biopsy if possible.

Cu plačere.

Cheers, John.

User
Posted 18 Nov 2021 at 07:08
Tiberiu

I would agree with John get the biopsy, it will give a much clearer picture sooner the better, the biopsy is nothing to worry about a small amount of discomfort and thats it.

All the best

Keith

User
Posted 18 Nov 2021 at 07:58
The only way to know whether or not you have prostate cancer is to look at cells under a microscope. A biopsy is nothing to worry about. It's uncomfortable but shouldn't be painful.

Best wishes,

Chris

User
Posted 18 Nov 2021 at 11:51

Wow, thanks for the quick responses, you are all so kind, and I apologize if I seem a little panicked.
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 (lobe which in most cases is correlated with benign prostatic hyperplasia).
As for the biopsy, 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.
I will try to find a radiologist who specialises in reading prostate images and also I will make an appointment with another urologist to see what he says and if he also recommends a biopsy, I will do it!... but I will have to wait until January when I will be able to benefit from my wife's health insurance. I currently have no financial income because of Covid ( my job is musician).

Best wishes

Tiby

 

For Barry:

MRI Technique: T2 weighted sequences , T1, PROPELLER in different planes, diffusion , AX 3D T1 LAVA
(Water , Fat, IPOP) before and after paramagnetic contrast injection.

I assume that is multiparametric MRI.

The proposed biopsy is TRUS type. Transperinal is rare to find in our country.

Edited by member 18 Nov 2021 at 11:59  | Reason: Not specified

User
Posted 18 Nov 2021 at 12:47
To be honest, I don't think the MRI is the most important thing here. The fact that the urologist felt a possible nodule is the main concern and a sound reason for a biopsy.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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