Advice on this very much appreciated

User

Posted 06 Mar 2025 at 17:32

Hi there

I am 57 and after experiencing increased urges to urinate, my doctor wanted to check my Serum Prostate Specific Antigen Level and do a physical check of my prostate. Although the blood result was 1.37, he discovered abnormalities in the prostate.

My consultant confirmed this and I had an MRI scan two weeks ago.

I have just been told that I have a Pi-Rads 3 diagnosis. The consultant has said he wants to monitor my blood over the coming months and not do a biopsy.

Doing research online it appears that usually having a 3 grade means having a biopsy.

He said the biopsy would be very unpleasant and to be avoided at the moment. It slightly felt like I was being fobbed off. But that might have been my high level of anxiety.

Has anyone else experienced this? Should I push for a biopsy? Any words of advice gratefully received.

Thanks so much

Just seen the report in detail it says:

Background:

Abnormal DRE

PSA 1.37 in Jan 2025

No bothersome LUTS

MRI prostate - prostate size 46 ml, PSAD is 0.02, PIRADS 3

Mild BPH changes are noted. No haemorrhagic signal within the prostate gland.

There is subtle low T2 signal change in the right apical posterior medial periphral zone which demonstrates subtle low ADC signal and enhancement (PiRAD3, Likert3). Nonspecific low T2 signal changes seen in the rest of the peripheral zones, likely inflammatory in nature.

No suspicious lesion in the seminal vesicles.

No gross abnormality in the anorectal junction or the minimally distended urinary bladder.

No enlarged pelvic nodes.

No suspicious bony lesion.

Conclusion:

PiRAD3,Likert3 area in the right peripheral zone with inflammatory changes in the rest of the peripheral zones.Mild BPH changes

If anyone can tell me what this means I would be grateful!

Edited by member 28 Mar 2025 at 09:19 | Reason: Not specified

User

Posted 06 Mar 2025 at 20:33

I'm not too sure that Pirads3 is usually a biopsy. It probably is if accompanied by a high PSA.

One PSA test is not very useful, but two or more tests several months apart are useful, because then you can see which way the PSA is moving. I think the consultant is right to do more blood tests rather than do a biopsy.

Prostate cancer is very slow, you have hardly any signs of (except the prostate abnormalities). Waiting a few months will make no difference to the disease if it is present.

Edited by member 07 Mar 2025 at 00:12 | Reason: Not specified

Dave

User

Posted 06 Mar 2025 at 20:52

Seems reasonable TBH. Just make sure you get the follow up.

User

Posted 06 Mar 2025 at 22:33

I'm with Dave and francij1.

User

Posted 07 Mar 2025 at 10:49

Hi Richie

I can only agree with my other fellow club members. PIRADS 3 is 50/50 chance at best, of anything sinister being present, and your PSA level is very low. I would go with the recommended waiting, and put off having a biopsy unless things change. They aren't much fun to be fair 👍

Ian.

Edited by member 07 Mar 2025 at 10:50 | Reason: Not specified

User

Posted 08 Mar 2025 at 11:35

Hi Richie,

Score another one in favour of following the doctors advice.

My MRI came back a 4 and that triggered a biopsy, which, although I wouldn't have one as a hobby, wasn't as bad as I thought.

The biopsy came back negative for cancer cells.

The 3 score your MRI gave you means it's not necessary to have the invasive biopsy at this time.

I know how hard it is when you think there is something going wrong inside you, but you have to be realistic and appreciate that sometimes watchful waiting is the best option.

As previously said just keep on top of future tests. My GP has been fantastic and pencilled a reminder in my medical notes to call me in for a psa test at the appropriate time so I don't forget.

Mick

User

Posted 08 Mar 2025 at 12:48

It is unfortunate that it was not mentioned what the irregularity was in the Prostate. It could be that it is rather large which is known as BPH. The Prostates of some men grow more quickly than in others and this of itself does not signify cancer. Agree that regular monitoring by PSA should be done.

Barry

User

Posted 08 Mar 2025 at 23:28

The urinary symptoms are normally symptoms of an enlarged prostate.
Prostate cancer doesn't usually have symptoms (until it spreads elsewhere, in which case the symptoms are wherever it's spread to).

Do you know how large your prostate is? (This will be in the MRI report.)

If you are not having a biopsy, I would insist on 3-monthly PSA tests for a year to get the rate of change, and then maybe another MRI to compare with the current one (which is a bit like Active Surveillance, although that can only strictly be offered after a biopsy).

User

Posted 28 Mar 2025 at 09:20

Background:

Abnormal DRE

PSA 1.37 in Jan 2025

No bothersome LUTS

MRI prostate - prostate size 46 ml, PSAD is 0.02, PIRADS 3

Mild BPH changes are noted. No haemorrhagic signal within the prostate gland.

No suspicious lesion in the seminal vesicles.

No gross abnormality in the anorectal junction or the minimally distended urinary bladder.

No enlarged pelvic nodes.

No suspicious bony lesion.

Conclusion:

PiRAD3,Likert3 area in the right peripheral zone with inflammatory changes in the rest of the peripheral zones.Mild BPH changes.

User

Posted 28 Mar 2025 at 11:41

My MRI showed Pirad 4 so a biopsy was a necessity, and as others have said, it wasn't as bad as I thought it might be although I'd rather remove painted woodchip from a ceiling given a choice and believe me that isn't fun.

Whether you wait or proceed to biopsy in my view is down to can you cope with the 'not knowing', if the medical advice is wait & see then clinically you should be fine to do just that, it's just about you and how you deal with it.

It's similar to those of us who have had a biopsy, received a positive diagnosis and then been offered Active Surveillance. Those who can deal with living with that do, those that can't, like me, don't and have treatment.

Good luck with your journey, the forum and the wider website is a great resource.

User

Posted 28 Mar 2025 at 12:19

Yes I have a pirads 3 and personally chose to be monitored than a biopsy (as in my case considered more likely inflammatory than malignant)

EAU guidelines are that (for PIRADS 3) under a certain PSA density, the recommendation is "no biopsy" or "consider biopsy".

Regarding your anxiety, I can only encourage you that I was the same and over a few days it has decreased significantly.

Edited by member 28 Mar 2025 at 12:31 | Reason: Not specified

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