mpMRI PIRADS score of 4

User

Posted 21 May 2022 at 17:15

I had a nasty high fever and Urinary Tract infection last month between 10th - 15th March and was treated with antibiotics. Had Trouble urinating, with the urge to go frequently and pain/discomfort in my penis or in my Urethra Tube. Treated with Antibiotics and symptoms have improved now. Two weeks after UTI a PSA test and the result of which come now 16.5. In April I again did the PSA test and Urine Culture. PSA increased to 17.75 from 16.7 in a month's time and urine Culture also come positive for bacterial Bugs. GP thoughts it is due to Prostaritis and recommends me the 4-week Antibiotics based on the bacteria in the Urine Culture. In the meantime, I have seen urologist consultants privately Who did the mpMRI and it also shows some cancer sign sessions with a PIRADS score of 4. Now urologist asking me to take an opinion from a second urologist privately to decide if I go for Biopsy or not. I have again given my Urine Sample for culture to check if the Bacterial bugs have gone or not .. Now I am worried about having the PC because of the MRI scan and am confused if I should go for TRANSPERINEAL BIOPSY or not or Should I also go for a Semen Culture test as well to see if it is due to prostatitis or if still there is bacteria or inflammation in my prostrate.

Edited by moderator 07 Dec 2022 at 11:07 | Reason: Not specified

User

Posted 22 May 2022 at 03:01

As regards UTI, this can skew PSA but it seems sensible to follow the advice of your GP to take a course of antibiotic to fight what was found in your urine sample. Sometimes a UTI can prove very difficult to overcome. An transperineal biopsy covering suspicious areas of your prostate at an appropriate time should enable a better assessment to be made but it is possible that a bone scan will be called for. Are you intending to continue to see consultants privately, as if not, you could ask your GP to refer you to Urology within the NHS. It could be helpful if you got a copy of the MRI scan you had to give to the NHS Urologist. Examination of this and hopefully an infection free tract may help determine whether a biopsy should then be the the next step.

Barry

User

Posted 22 May 2022 at 09:38

A biopsy is the only way to know whether or not you have cancer, but it would seem sensible to get the UTI sorted first.

Best wishes,

Chris

User

Posted 22 May 2022 at 09:53

Frankly without a biopsy there is always going to be a doubt as to what's going on. After my MRI I was T2 PRIADS 4. TP Biopsy was offered and I had no hesitation in accepting. It's not a pleasant procedure but I was back at work the same day, gym the next and hiking at the weekend One Item of note our NHS Urology department will not carryout a biopsy if you have a UTI. In fact on the morning of the biopsy they test your urine.

User

Posted 22 May 2022 at 10:27

Thank You everyone for your kind advice

To update, presently I am under the care of a Private Urologist through my BUPA insurance and he advised me the MRI and hopefully will get a full diagnosis including Biopsy, bone scan and others through him as my NHS consultants put me on a 4-week antibiotics course which is ending by end of this month. He asked me to have the PSA test afterwards and if the number of the PSA test is increased then he will order the MRI as he thinks that my increased PSA is due to prostatitis which needs a long term antibiotic treatment to cure and not a standard 7 or 10 days course. So I am presently under both NHS and private urologist.

Moving forward I am thinking of having the following plan

1) Complete full antibiotics course as advised by NHS urologist

2) Afterwards, have a Urine Culture test to check if the bacterial bugs and prostatitis is clear or not

3) Get the Seamen culture test to check for any bacterial as if the prostate function is to produce the seamen fluid so the culture test will definitely confirm if there are any bugs or not

4) If all above bacterial UTI and Prostaritis test is cleared then wait for 4 weeks to test for PSA to check if the number is increased or decreased. If increased PSA is due to prostatitis then PSA number should definitely decreased.

5) I also want to wait for a Biopsy thinking prostatitis inflammation may have some effect on the grey area of the MRI cell and they might cure on its own before I carried out MRI and Ultrasound fusion Biopsey privately with my insurance.

After completion of Antibiotics and negative Urine Culture, I should not wait to see the PSA number and go straight to Biopsy to save time and complete the diagnosis without wasting further time please

I am very stressed and disturbed seeing my MRI Scan as I am 56 years old single and live by myself so this MRI PC result is just killed my peace.

I request all of you to help, advise and amend my plan of action if I am missing some puzzle in the game ..

User

Posted 22 May 2022 at 14:00

My suggestion is go with what the professionals say, where they advise on a course as they have a better knowledge of your case than you or us here. If they they say there is an alternative that you could follow, that is just as good, then make the choice of how you go about things yourself.

Barry

User

Posted 23 May 2022 at 14:51

I received the Urine Culture which is negative and the mpMRI report today and the finding is as follows

BASIC ASSESSMENT

PSA - 17ng/ml

Prostate Volume - 37ml

PSA Density - 0.46 ng/ml2

PIRADS - 4

Extracapsular extension and Seminal Vesicle invasion - No

Assessment Summary:- The diffusion images unfortunately are degraded by rectal artefacts partially obscuring the posterior zones so the PIRADS score is based on the T2 and post contrast image

POSTERIOR LESIONS - PIRADS 4

PR01 - 6.8 mm (LA) X 5.9 mm (SA) in posterior Zones left

PR02 - 11.3 mm (LA) X 4.8mm (SA) posterior Zone Right

Questions:

1) What does a PSA density of 0.46 means . if the number is too high. Don't know What is the normal limit

2) Are these Lesion sizes and locations are hard to treat

3) if the prostate lesion shows that it is localised :

4) I have a follow-up appointment with Urologist Consultants on Friday to discuss the MRI result and book the Biopsy - Please advise any specific questions to ask him based on the MRI results

Any further comments on MRI result findings are highly appreciated. Definitely Based on above I have to go for Biopsy now so very scared and stressed

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