Prostate Pre-Biopsy Multiparametric MRI False Positives

[plee12]

I was wondering if anyone has heard of PIRADS 4 and 5 lesions that turned out to be false positives?

[TylexGP]

Yes the tech that was in the room with the Urologist taking my biopsy samples said he had seen Pirad 5 lesions that were negative for PCA. That was not the case for me.

[plee12 in reply to TylexGP]

TylexGP,

Thanks very much for your feedback.

The reason I asked that question is that about one month ago my pre-biopsy mpMRI results came back positive with a Pirads 4 and a Pirads 5 lesion.

Ideally, before I commit to a needle biopsy, I would like to repeat the MRI pre-biopsy and then compare the two MRI results to see if the results are reproducible or not (perhaps false positives due to inflammations or other conditions that can masquerade as cancer on the MRI images), or if one or more of the suspicious areas disappears, stays the same, progresses in size, or if any new suspicious lesions pop up. At the same time, I continue to monitor the progression of the PSA.

If anyone else can provide additional data points regarding false positives from pre-biopsy mpMRI scans, that would be greatly appreciated.

Thank you

[Justfor_ in reply to plee12]

A friend of mine had mpMRIs and targeted biopsies twice. Both time the biopsy found nothing when the second mpMRI spotted progression. His PSA has been steadily climbing and free to total ratio declining. His urologist tells him there is nothing he can do given a negative biopsy. I am convinced that one day he will be greatly surprized.

[plee12 in reply to Justfor_]

Justfor_,

Thanks very much for another data point.

Do you happen to know the specifics of both mpMRI results in terms of Pirads 1,2,3,4, or 5 lesions?

Thank you

[Justfor_ in reply to plee12]

The first was PIRADS 3, the second was upgraded to 4. Almost two years between the two.

[plee12 in reply to Justfor_]

Justfor_,

Very interesting data point.

Also, do you happen to know approximately his PSAs at the time of his two MRIs?

Thank you

[Justfor_ in reply to plee12]

Only sure about the second 11.x. The first should had been somewhere between 9 and 10. I can find out if this is important to you.

There is a side road for you to check before going the biopsy route. Take Avodart for 6 months and if your PSA halves or about then it is the real thing. There is always the PSMA PET, but you will have to pay out of pocket.

[plee12 in reply to Justfor_]

Justfor_,

That's good enough. No need to follow up.

I'm not sure what you meant by "I am convinced that one day he will be greatly surprized." You mean you expect him to have cancer some day in the future, even though his biopsy was negative?

Can you please clarify?

[Justfor_ in reply to plee12]

I am expecting him finding out about his ongoing cancer some time in the future.

[plee12 in reply to Justfor_]

Justfor_,

Thanks for mentioning Avodart. I wasn't aware of such a thing.

I just looked it up, and it's supposed to reduce the size of an enlarged prostate. But, how does that tell you whether or not you have cancer? I must be missing something. Can you perhaps explain?

[Justfor_ in reply to plee12]

PSA is a mix composed of benin and cancerous origins. By suppressing the former a clearer picture of the latter reveals.

[Jpl506]

I beat these bushes after my MRI showed a PIRADS 4. Had a 2nd opinion read from the chair of radiology at a comprehensive cancer center. Same results. Saw three different urologists and all said it could be a false positive but biopsy is the only way to know for sure. Damned if it wasn’t right. 9/12 positive cores mostly 4+5 and 5+4 but 1 was 5+5. I guess I should have bought a lottery ticket.

[Justfor_ in reply to Jpl506]

If memory serves the specificity of mpMRI read by a competent radiologist is above 90%. Urologists earn a substantial part of their paychecks by performing biopsies. They will keep pushing for a biopsy no matter what.

[Jpl506 in reply to Justfor_]

I’m glad they got paid.

[Hidden]

Have a good read. pubmed.ncbi.nlm.nih.gov/330...

GD

[plee12 in reply to Hidden]

gourd_dancer,

That was a great read. Thanks so much!

[j-o-h-n]

Greetings plee12,

Would you please be kind enough to tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/19/2022 3:08 PM DST

[plee12 in reply to j-o-h-n]

j-o-h-n,

Ok done. Thanks for reminding me.

[j-o-h-n in reply to plee12]

I am posting this for plee12 since I think it deserves some responses.

Thank you!!!

j-o-h-n

Hello,

Just joined this group a few days and hoping to get some members' insights on my situation.

Here's my situation:

Because of a recent trend of elevated PSA,

Feb 2020 4.3

May 2020 4.9

Nov 5 2020 5.8

Nov 22 2021 6.7

About one month ago I got a multiparametric MRI scan of my prostate

(pre-needle biopsy). The results came back positive

as follows:

1. R1: a 1.8 cm lesion in the right anterior to

posterior transition zone at the base to apex of

the prostate is highly suspicious for prostate cancer

(PI-RADSv2.1 category 5).

2. L1: a 1.0 cm lesion in the left anterior peripheral

zone at the base to mid gland of the prostate is

suspicious for prostate cancer

(PI-RADSv2.1 category 4).

3. L2 L1:0.6 cm lesion in the left posteromedial

peripheral zone at the mid gland and of the prostate

suspicious for prostate cancer

(PI-RADSv2.1 category 4).

However, strangely, it also reported the following:

"The prostate is normal in size measuring 4.7 x 3.3 x 3.6

cm (volume 29 mL)."

Based on the results, my urologist wants me to do

a needle biopsy right away.

Since my prostate size is very normal for my age (69), and

my PSA of 6.7 is still quite reasonable for my age, I'm

questioning the wisdom of doing a needle biopsy at this

time.

Ideally, I would like to wait perhaps 6 months to one year

to repeat the MRI biopsy and then compare the two MRI results

to see if the results are reproducible (perhaps false positives due to

different kinds of inflammations or other conditions that can masquerade

as cancer on the MRI images?), or if one or more of the suspicious areas

disappears, stays the same, progresses in size, or if any new suspicious

lesions pop up. Also, even before repeating the MRI, I continue to monitor

the progression of the PSA.

I think I'm still in a position to buy some more time without

putting myself at risk?

Would appreciate any thoughts on this.

Thank you,

Peter

RSVP

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/19/2022 4:04 PM DST