I've been on AS for over a year after being diagnosed with low grade (Gleason 3+3) in Feb of 2016 but had a biopsy in 2013 with negative results but continued to have an increasing PSA (4 in 2010, 8 2013, 12 2016 and now 15)...Just had an MRI and have to make a decision. Another biopsy targeted to the area that the MRI suggests there might be cancer in the anterior part of the prostate.
Looking for advice based on their finding....
An area of markedly hypo intense signal on ADC map/hyperintensity on high b value DWI straddling on the anterior horn of the left apical peripheral zone and the anterior fibromuscular storm measuring 1.9 x .9 cm on axial image 25 series 8 (PI-Rads DWI score of 5). Corresponding masslike T2 signal abnormality and early enhancement measuring about 1.5 cm cephalocaudad. The mass abuts and bulges the outer prostate contour. In the middle this bulge abuts the cephalic aspect of the sphincter urethrae muscle. To the left of midline the tumour signal takes the angular shape of the space between the left side of the sphincter urethrae muscle and the elevator and, abutting the surface of these muscle but not visibly invading their substance. Anteriorly, the step-off between the right side tumour mass and the outer prostate contour is about .3 to.4 cm.
Elsewhere the prostate has indistinct hypo intensity on the ADC map and the striated T2 hypo intensity (PI-Rads DWI/T-2 score of 2)
Transitional zone: Heterogenous without focal finding of note.
Elsewhere the outer prostate contour smooth. Neurovascular bundles appear symmetric. Seminal vesicles do not appear involved. No enlarged pelvic lymph nodes identified. A non-specific focus of decreased T1 signal with the left femoral head.
Do I get a biopsy to determine the grade of cancer?
Radiology or Prosatectomy?