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MRI with contrast

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User
Posted 13 Mar 2025 at 07:44

Hi, I have PSA of 4.6 which prompted an MRI  with contrast. Results reveal a 5mm lesion with Pirad of 4. No metastic signs outside of prostate. Oncologist suggested watchful waiting as lesion is 5mm. Another PSA in 3 months as monitoring method.. I am 68 . I would  appreciate some feed back from this community as to whether this is the right approach or to go for biopsy. Thanks

User
Posted 13 Mar 2025 at 11:10
As it's the recommendation of your oncologist we have to assume it's reasonable!!

If you were 48 I would say definitely not reasonable and go for the biopsy.

If you were 88 I would ask why you even bothered with an MRI.

So it's really all about your risk appetite and life expectancy.

The risks I would be considering are:

Biopsy is a procedure with a not insignificant risk.

It could be a high grade cancer that is about to metastasise.

Perhaps focus your thoughts on the above and decide which outcomes you can best live with.
User
Posted 13 Mar 2025 at 15:42
Thanks for the reply. Yes the ambiguity is so frustrating. Hope for the best
User
Posted 13 Mar 2025 at 17:40

I'm 64, PSA 4.9 prompted an MRI which also showed Pirads 4 and 'changes' to my prostate but these were contained. That prompted a biopsy which confirmed cancer with a max 4mm lesion. That prompted a recommendation of AS. All of this on the NHS. Following that I saw both an Oncology & robotic surgeon who confirmed that AS should be fine but that given my diagnosis both offered 'cure' if I proceeded. After much deliberation I'm having RARP on 8/04.


It appears that one's age and therefore one's life expectancy plays a huge part in the NHS recommendation process. Given what I know now I'd suggest you ask for a biopsy and get a full diagnosis and then you'll be in a position to make an informed decision as to your next move.


Best of luck 


 

 
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