Hello, due to a PSA elevation of 6.8 ng/ml, he was recommended to undergo an MRI, and these are the results. I am quite worried about him.
The prostate has maximum diameters of 7.3 x 3.7 x 5.5 cm, with an estimated volume of 78 cc. In T1-weighted sequences without intravenous contrast, a slight signal intensity alteration is identified, appearing as faintly hyperintense areas of indeterminate significance, which, in any case, do not correspond to a suspicious lesion.
There are stromal and glandular hyperplasia changes in the transitional zone, appearing broad, predominantly iso- and hyperintense, with an impression on the bladder floor. No focal hypointense areas in T2 are observed that would suggest clinically significant cancer.
The peripheral zone is broad, with moderately heterogeneous signal intensity, highlighting a PI-RADS 3-4 lesion of approximately 8 mm in maximum diameter (measured on the ADC map). It is located in the posteromedial peripheral zone of the prostatic apex and appears as:
If confirmed, the lesion presents a nodular appearance that may extend beyond the posterior glandular border, potentially corresponding to a focus of extraglandular extension, although the length of contact with the glandular contour is less than 1 cm.
No other suspicious lesions are identified in the rest of the gland.No pelvic or inguinal adenopathy.Small, millimetric, indeterminate left mesorectal lymph nodes.No suspicious bone lesions identified.Small right sacral root cyst at S2-S3.Stress bladder.Small left inguinal fat-containing hernia, medial to the inferior epigastric vessels (likely direct).
Murdock, the report is probably a bit to technical for most of us to understand. If you were in the UK I would suggest you call the specialist nurse number at the top of the page. Not sure if the chat and email service they provide extends outside the uk.
Thanks Chris
Hi Murdoch.
How old is your dad? His prostate is double normal size, that alone could elevate his PSA. I'm not medically trained but I think the MRI scan seems to have picked up a suspicious area that needs further investigation, especially as it appears to have have extended beyond the prostate.
I would think the next step would be a biopsy to establish the exact nature of the lesion.
Hi again.
I had extraprostatic extension with extensive Gleason 9 (4+5) and they took six months to get me sorted. I'm pretty sure your dad will be okay mate. Best of luck to you both.🤞
Murdock, they found I had extra prostatic extension after my surgery 11 years ago ,I also had positive margins , I'm still here.
yeeeahh this is great!. Thank you very much friend, I hope and wish that
you continue here for many more years.
All the best
Sorry mate, I didn't realise surgery had been ruled out in your dad's case. Not to worry, there are plenty on here that have had similar diagnosises, and have had as good results with radiotherapy/HT.
Hello Adrian, my father is 78 years old. Precisely that fact of possible extraprostatic extension, although it seems to be minimal, is what has me really stressed. It seems incredible how an 8 mm lesion could already be coming out of the prostate.
The urologist has talked about doing the biopsy in approximately
3 months but it seems too long to me.
Edited by member 07 Feb 2025 at 09:04 | Reason: Not specified
Bad news with my father 78 yr old men. Biopsy results:
Bx fusionA-D: Pirads lesion, 4 in the left apexE-F: Left perilesionG-J: 4 random lesions on the left sideK-O: 5 random lesions on the right sideGleason grade 10 (5+5) acinar adenocarcinoma,
A-D: Pirads lesion, 4 in the left apex
E-F: Left perilesion
G-J: 4 random lesions on the left side
K-O: 5 random lesions on the right side
Gleason grade 10 (5+5) acinar adenocarcinoma,
affecting cores in samples A (5%), C (40%), D (40%), and J (3%).
Plan: PSMA PET
I am devastated and also thinking about the possible implications this may have on the management of my Gleason 6
Edited by member 24 Jun 2025 at 16:49 | Reason: Not specified
Hi murdock,
I'm sorry to hear that your dad is Gleason 10 (5+5). As I said, mate, over two years ago when I had my op, I was Gleason 9 (4+5) with EPE. I'm still doing fine with undetectable PSA. I hope that your dad is as lucky as me
It's weird that both him and me had relatively low PSA with such high Gleason scores.
Good luck to you both.
Edited by member 24 Jun 2025 at 17:24 | Reason: Additional text
Hi Adrian. Thank u for ur answer.
my father in 2006 have rectum Cancer
treated only with surgery. I hope this don't be an inconvenience for treat now.
And i am sure this will have impact in my active
surveillance management.
I understand that very aggressive tumors produce little PSA
Has anyone been in a similar situation? I know it's difficult because I see few GS10 cases on the forum. This is too harsh.
Update news 17 July 2025 my Father
TC thoracoabdominopelvic is clear.PSA at January 2025 is 8.44 ng/ml and now is 7.33 ng/ml.Biopsy confirmed 8 mm tumour Gleason 10 (5+5). MRI show possible focus EPE < 1cm
Today is done PET-PSMA and next 23th July is consultation for results.Possible T3aN1M0 because gleason 10 is very agressive, but not yet PET-PSMA results.
HT is the best and only way because RT very difficult or impossible because he have previous rectal cancer surgery with anasthomosis ultra low 17 yrs ago. Will se what think radioterapeutic oncologist but i am not optimist.
I think not curable and hardly treatable and poor prognosis.
Thx.
Edited by member 17 Jul 2025 at 21:29 | Reason: Not specified
Hi again Murdock.
My late father was diagnosed with prostate cancer when he was in his late seventies. I'm ashamed to say that I didn't know what his exact cancer staging or his Gleason score were. However, now I know more about the disease, I believe it must have been pretty bad.
He told me that they were unable to 'operate' on him and that he would be having injections in his stomach every few months. I now assume this was some some of hormone thearpy. He soldiered on for at least another ten years, living relatively normally.
About a month or two prior to him passing away. He complained of his left leg and lower back 'playing him up'
I took him to his GP who contacted his ururologi. At this time his PSA was in the thosands. The following week I took him for a bone scan. It was only at this stage that I realised how extensive his disease had been.
The next morning I was contacted and told under no circumstances should I transport him again because his bones were so badly effected.
I never thought of my dad as a particularly strong guy, but I now know what a brave bloke he was.
I'm sorry that the details of my dad's case are sketchy but I just wanted you to know that in his case, without surgery or radiotherapy, it was possible for him to live for many years without his quality of life being too badly affected.
Edited by member 18 Jul 2025 at 23:23 | Reason: Typo
Hello again... Adrian56 thank u very much
I’m writing to share my father's case and to hear thoughts from others who may have faced something similar — especially concerning low-PSA, high-Gleason tumors.
🔹 Age: 78🔹 Biopsy result: Adenocarcinoma acinar, Gleason 5+5 (Grade Group 5)🔹 MRI (Jan 2025): PIRADS 3–4 lesion, 8 mm in the left peripheral zone, with suspected focal extracapsular extension <1 cm🔹 PET-PSMA (July 2025): "Extensive prostatic lesion without clear evidence of nodal or distant spread" → staged as cT3aN0M0🔹 Prostate size: 78 cc.🔹 PSA trend:– Jan 2025: 8.44 ng/mL– Jul 2025: 7.33 ng/mL (decrease without treatment)
🔹 Current status:– No metastases– Good general health– Very low rectal anastomosis due to past rectal cancer surgery– Recently started Orgovyx (relugolix)
🔹 Next step: Awaiting evaluation by the radiation oncology team and decision from a multidisciplinary tumor board to determine feasibility of curative radiotherapy, given his rectal surgery.
🟡 My concerns:
I’m struggling with anxiety due to the apparent discordance:
The Gleason score is 10, but PSA is relatively low and has even decreased.
The MRI lesion is small, and PIRADS 3–4, not PIRADS 5.
The PET-PSMA shows a “large” lesion, but no spread beyond the prostate.
A well-known Japanese radiation oncologist said that a GS 5+5 with low PSA might suggest a risk of neuroendocrine or small-cell differentiation in the future — and now I’m very worried.
💬 If anyone has experience with similar cases (GS 9–10, low PSA, localized disease), I would be very grateful for your insights or emotional support.Thank you so much.
Edited by member 28 Jul 2025 at 09:55 | Reason: Not specified
Hi again, mate.
Your dad's diagnosis is identical to mine, my prostate was about the same size. I ended up T3a N0 M0, with extraprostatic extension, my PSA was only 6, but I had Gleason 9 (4+5).
I had RARP. The surgeon removed the seminal vesicles and 9 lymph nodes. Fortunately, he appeared to have done a thorough job, and I had negative margins.
Since the op, which was over two and a half years ago, my PSA has remained undetectable at <0.02. I'm obviously hoping it remains that way and that I avoid biochemical recurrence and the need for further salvage treatment.
As I understand it, if after the op, if your PSA is undetectable and you've got negative margins, your pre op Gleason doesn't matter that much apart from it still being a factor which can increase the risk of BCR.
Your dad's results, in the grand scheme of things aren't that bad, and a lot better than I first thought they'd be.
Good luck, mate.👍
Edited by member 29 Jul 2025 at 09:16 | Reason: Typo
It seems to be confirmed that ISUP 5 tumors (the most aggressive) are low PSA.
In my father's case, surgery has been ruled out because it was considered quite complicated.
On September 1st, he has an appointment with a radiation oncologist to evaluate his case,
given his previous rectal surgery.
Let's keep our fingers crossed that a curative treatment can be applied
without causing too much damage to the intestines.
B.R.
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