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Likert 4 on MRI but 16 core biopsy negative

User
Posted 07 Nov 2025 at 09:55

Hello all, thanks for this fantastically informative forum, grateful to everyone for sharing their stories. 

Here's mine: 48M, father had prostate cancer so got PSA test at health check. PSA range from 2.25 to 2.97 across 2 separate readings, so forwarded for MRI. 

Prostate normal size at 27cc. BUT one small 1cm indeterminate lesion identified in transition zone (so unusual area) graded at Likert 4, which was obviously a shock. On to a TP biopsy (which I found quite horrible tbh). 16 cores taken with 4 fusion targeted into lesion. Consultant said he thought it was likely to be low grade cancer, but could equally well be nothing (eh?).

Psychologically prepared for cancer but just got the letter to say nothing found in any of the 16 cores. Nurse now wants to discharge me back to GP.

Obviously I'm hugely relieved and feel very grateful for this news, but confused as to what to do next. There is always the small possibility the target lesion was missed, although with 4 cores taken you'd hope they managed to hit it with at least one.

PSA is still slightly raised for my age, but the feeling seems to be the lesion is probably prostatitis, or inflammation from a previous UTI.

What a rollercoaster.

 

 

User
Posted 07 Nov 2025 at 12:50

Hi,
Your psa isn't that high for most people.  A change over 2 readings might not be enough to properly judge.  Perhaps the GP will suggest on-going psa checks to see how or if it's changing over a longer term.  Even if it is changing it might be benign.  There's a risk of overtreatment as it's hard not to be cautious.  We're all different and you might worry yours is the case that breaks the rules.  I think I'd be looking for another psa test and make sure I was very careful about the conditions such as not riding bikes, doing exercise, having sex etc in the week before especially the 48hrs before the psa test and then do that for your future tests to create similar conditions.   All the best, Peter

 
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