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User
Posted 12 Mar 2025 at 12:21

Now its my turn.  I had a PSA of 3.5 in my 2024 annual physicial.  This year in January it was 4.4, then after retest in February it was 5.1.  So I went to see urologist last week.  He did a DRE and found a "pea sized" lump.  Ordered an MRI to be followed by a biopsy.  Luckily I was able to get in for an MRI Monday.  Results came back like this:

FINDINGS:

PERIPHERAL ZONE:

Lesion 1.

A 1.5 x 1.2 x 0.9 cm lesion posterolateral right peripheral zone mid gland/apex (series 6 axial image 20).

T2 appearance: Circumscribed, homogenous hypointense focus/mass greater or equal to 1.5 cm.

Diffusion-Weighted Imaging: Focal markedly hypointense on ADC and markedly hyperintense on DWI.

Enhancement: Positive.

Prostate margin: Approximate 3 mm posterior extracapsular extension with encroachment on the adjacent neurovascular bundle.

Diffusion abnormality meets PI-RADS 5.

Region of interest created for biopsy and/or follow-up.

 

TRANSITIONAL ZONE: No focal finding. Stromal and glandular BPH.

 

No seminal vesicle invasion.

No pelvic lymphadenopathy.

No lesions in the visualized bones.

 

PROSTATE GLAND VOLUME: 33 cc

 

IMPRESSION:

1. Lesion 1 right peripheral zone with minimal extracapsular extension and encroachment on the neurovascular bundle is assigned PI-RADS CATEGORY 5: Very high. Clinically significant cancer is highly likely to be present.

 

So next is a biopsy.  I did reading on the google yesterday and learned there is a ton of conflicting information.  However, I stumbled on this site and have really appreciated the support I have seen for other folks here.  I sure could use some right now as I am terribly scared.  I am a very (otherwise) healthy 59 year old guy and have no idea what lies in store for me.  My care team sent a note this morning saying they would be calling me this week to schedule a biopsy. 

 

Just getting my thoughts on a post here is helpful.  Knowing it will be read by others who started this journey long before me is even better.
User
Posted 12 Mar 2025 at 13:04

That's a nice detailed MRI report. Not a very high PSA, and not increasing too fast.

T2 appearance I think refers the imaging parameters. You do not have a T2 tumour, with the extra prostatic extension and nerve bundle invasion, I am pretty certain this will be classified as a T3 tumour.

Biopsy will be useful to know your Gleason score.

I presume a MDT meeting will then happen and they will recommend a treatment, my guess would be some kind of radiotherapy, but they are the experts not me.

Dave

User
Posted 12 Mar 2025 at 17:04
Hi Darren

Your MRI report is very detailed which is fantastic, but your biopsy will give you a definitive answer and will determine your next course of action. It's easy for me to say, but don't get hung up on every word of the report and try to second guess what the MRI is telling you. I'm sure we all did the same, I know I did. The hardest part is the waiting and it is scary. It's the unknown and our minds naturally go into overdrive. The most important thing, is that you are having the investigations now and not in say five years time. Once you have your diagnosis and a plan is put into place, you will feel more in control.

The guys and partners on this site are an invaluable source of live knowledge. I cannot express how important this site has been to me personally and to countless others. I'm sure you'll get a tremendous amount of support on here. As Ian said above, keep us updated and I wish you all the best.

Incase you haven't been told, (I'm sure you have) start doing your pelvic floor exercises.

Best

Seb

User
Posted 12 Mar 2025 at 12:21

Now its my turn.  I had a PSA of 3.5 in my 2024 annual physicial.  This year in January it was 4.4, then after retest in February it was 5.1.  So I went to see urologist last week.  He did a DRE and found a "pea sized" lump.  Ordered an MRI to be followed by a biopsy.  Luckily I was able to get in for an MRI Monday.  Results came back like this:

FINDINGS:

PERIPHERAL ZONE:

Lesion 1.

A 1.5 x 1.2 x 0.9 cm lesion posterolateral right peripheral zone mid gland/apex (series 6 axial image 20).

T2 appearance: Circumscribed, homogenous hypointense focus/mass greater or equal to 1.5 cm.

Diffusion-Weighted Imaging: Focal markedly hypointense on ADC and markedly hyperintense on DWI.

Enhancement: Positive.

Prostate margin: Approximate 3 mm posterior extracapsular extension with encroachment on the adjacent neurovascular bundle.

Diffusion abnormality meets PI-RADS 5.

Region of interest created for biopsy and/or follow-up.

 

TRANSITIONAL ZONE: No focal finding. Stromal and glandular BPH.

 

No seminal vesicle invasion.

No pelvic lymphadenopathy.

No lesions in the visualized bones.

 

PROSTATE GLAND VOLUME: 33 cc

 

IMPRESSION:

1. Lesion 1 right peripheral zone with minimal extracapsular extension and encroachment on the neurovascular bundle is assigned PI-RADS CATEGORY 5: Very high. Clinically significant cancer is highly likely to be present.

 

So next is a biopsy.  I did reading on the google yesterday and learned there is a ton of conflicting information.  However, I stumbled on this site and have really appreciated the support I have seen for other folks here.  I sure could use some right now as I am terribly scared.  I am a very (otherwise) healthy 59 year old guy and have no idea what lies in store for me.  My care team sent a note this morning saying they would be calling me this week to schedule a biopsy. 

 

Just getting my thoughts on a post here is helpful.  Knowing it will be read by others who started this journey long before me is even better.
User
Posted 12 Mar 2025 at 14:37

Thanks--quick question regarding "minimal extracapsular extension". Does anyone know if that always means a T3 type cancer or is it also possible to be a T2? Also the word "encroachment" rather than "invaded" is interesting to me.

I haven't found a lot of information about what "minimal" means.. but the word itself does provide some hope/comfort.

Edited by member 12 Mar 2025 at 14:45  | Reason: Not specified

User
Posted 12 Mar 2025 at 14:53

Hi Darren

Sorry you've had to join us, but welcome to the club. My understanding is that with any degree of EPE, it will be classified as a T3 tumour. 

I think as Dave says, RT is likely to be the recommended treatment (if indeed it turns out to be cancerous - still need those biopsy results to confirm that). I had surgery with a T3a Tumour, but only because it was a T2 as far as they were concerned, before they got in there and discovered it had grown.

Good luck, and keep us updated with your biopsy results and final diagnosis.

Ian.

Edited by member 12 Mar 2025 at 14:53  | Reason: Typo

User
Posted 12 Mar 2025 at 17:34

Originally Posted by: Online Community Member
Hi Darren

 don't get hung up on every word of the report and try to second guess what the MRI is telling you. I'm sure we all did the same, I know I did. The hardest part is the waiting and it is scary. It's the unknown and our minds naturally go into overdrive. 


Seb

great advice.  I'll work on that!

Show Most Thanked Posts
User
Posted 12 Mar 2025 at 13:04

That's a nice detailed MRI report. Not a very high PSA, and not increasing too fast.

T2 appearance I think refers the imaging parameters. You do not have a T2 tumour, with the extra prostatic extension and nerve bundle invasion, I am pretty certain this will be classified as a T3 tumour.

Biopsy will be useful to know your Gleason score.

I presume a MDT meeting will then happen and they will recommend a treatment, my guess would be some kind of radiotherapy, but they are the experts not me.

Dave

User
Posted 12 Mar 2025 at 14:37

Thanks--quick question regarding "minimal extracapsular extension". Does anyone know if that always means a T3 type cancer or is it also possible to be a T2? Also the word "encroachment" rather than "invaded" is interesting to me.

I haven't found a lot of information about what "minimal" means.. but the word itself does provide some hope/comfort.

Edited by member 12 Mar 2025 at 14:45  | Reason: Not specified

User
Posted 12 Mar 2025 at 14:53

Hi Darren

Sorry you've had to join us, but welcome to the club. My understanding is that with any degree of EPE, it will be classified as a T3 tumour. 

I think as Dave says, RT is likely to be the recommended treatment (if indeed it turns out to be cancerous - still need those biopsy results to confirm that). I had surgery with a T3a Tumour, but only because it was a T2 as far as they were concerned, before they got in there and discovered it had grown.

Good luck, and keep us updated with your biopsy results and final diagnosis.

Ian.

Edited by member 12 Mar 2025 at 14:53  | Reason: Typo

User
Posted 12 Mar 2025 at 17:04
Hi Darren

Your MRI report is very detailed which is fantastic, but your biopsy will give you a definitive answer and will determine your next course of action. It's easy for me to say, but don't get hung up on every word of the report and try to second guess what the MRI is telling you. I'm sure we all did the same, I know I did. The hardest part is the waiting and it is scary. It's the unknown and our minds naturally go into overdrive. The most important thing, is that you are having the investigations now and not in say five years time. Once you have your diagnosis and a plan is put into place, you will feel more in control.

The guys and partners on this site are an invaluable source of live knowledge. I cannot express how important this site has been to me personally and to countless others. I'm sure you'll get a tremendous amount of support on here. As Ian said above, keep us updated and I wish you all the best.

Incase you haven't been told, (I'm sure you have) start doing your pelvic floor exercises.

Best

Seb

User
Posted 12 Mar 2025 at 17:13

You're right it does say "encroachment". I read it fairly fast. "Minimal" is a nice word when talking about cancer, but "none" is even nicer. I would still guess they will say T3: it is not fully contained within the prostate. 

Dave

User
Posted 12 Mar 2025 at 17:34

Originally Posted by: Online Community Member
Hi Darren

 don't get hung up on every word of the report and try to second guess what the MRI is telling you. I'm sure we all did the same, I know I did. The hardest part is the waiting and it is scary. It's the unknown and our minds naturally go into overdrive. 


Seb

great advice.  I'll work on that!

User
Posted 13 Mar 2025 at 22:38

I think my sadness today is knowing that I feel great, no symptoms and actually am training for a 1/2 Marathon next month...but with this stupid MRI it's likely that I'm gonna have to soon make myself "sicker" to hopefully get better, and probably never to the way I feel today.

 
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