MRI PIRADS 5, but Biopsy negative?

[Vlad55]

Hi,

I am 64 years old.

I had two MRI scans recently and both times PIRADS 5 lesion with extracapsular extension and probable invasion of the right seminal vesicle have been reported.

After that I had Transperineal prostate biopsy and Histopathology reported no malignancy.

I am totally confused and I am worried that I would lose more time if biopsy was false negative, because I can’t start any treatment.

I would be very grateful if somebody with more experience and knowledge than me, could give me some advice or opinion about my results and some idea what I should do next.

I attached both MRI reports, 5 years PSA history and Biopsy report:

MRI 1:

I had Multiparametric MRI Prostate (3 Tesla scanner, intravenous gadolinium) on May 27, and radiologists reported the following:

The prostate measures 4.8x3.8x3.8 cm giving a volume of 36 cc.

Transition zone: Mild benign prostatic hypertrophy.

Peripheral zone:

Focal lesions:

1 - Location: right mid-gland to base, posteromedial to posterolateral PZ posterolateral PZ PIRADS 5 lesion, broad capsular contact is at high risk for ECE and with suspicion of invasion into right seminal vesicle. Seminal vesicles are otherwise unremarkable.

There are no abnormal lymph nodes identified. The bones of the pelvis are normal.

Size: 20 mm

T2: circumscribed hypointense rounded nodule

DWI: severe diffusion restriction (AAV 530)

DCE: +ave

PI-RADS rating: 5

2 - Location: left mid-gland posterolateral PZ

Size: 5 mm

T2: circumscribed hypointense rounded nodule

DWI: severe diffusion restriction (AAV 589)

DCE: +ave

PI-RADS rating: 4

ECE: low risk

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MRI 2:

On June 25, 2019 I had second Multiparametric MRI Prostate (3 Tesla scanner, intravenous gadolinium) in different hospital and I got the following report:

Prostate measures: 4.1x3.3x4.8. Volume 32.5 cc.

Peripheral gland:

In the right postero-lateral mid gland to base is a 1.8 x 1.9 x 1.0 cm low T2 area with marked restricted diffusion ADC 574 with extracapsular extension and abutment to right neurovascular bundle and probable infiltration to inferior aspect of the right seminal vesicle. This has the features of a high grade prostate cancer. Features are those of PI-RADS 5.

Central Gland:

Moderate features of PBH without obvious tumour.

T1 imaging of pelvis: No haemorrhagic change shown within prostate. No discrete bone lesion.

No pelvic lymphadenopathy.

-----

PSA:

August 8, 2019: PSA 5.7, Free to Total PSA ratio 12 %.

May 30, 2019: PSA 6, Free to Total PSA ratio 9 %.

August 22, 2018: PSA 5.7

June 22, 2018: PSA 5.3

February 03, 2017: PSA 4.56

November 04, 2016: PSA 4.64

February 18, 2016: PSA 4.14

September 24, 2014: PSA 2.85

-----

Biopsy:

On August 27, 2019 I had Biopsy and I got the following Histopathology report:

1. Right anterior - Four tan discrete cores 2, 2, 3, 4mm in length and multiple fragments less than 1mm. A1. - Sections show benign prostatic tissue.

2. Right mid - Six tan cores 2, 2, 3, 4, 4, 10mm in length and multiple fragments less than 2mm. A2.

- Sections show benign prostatic tissue.

3. Right posterior Lesion - Four tan cores 9, 13, 14, 15mm in length and multiple fragments less than 2mm. A2. - Sections show benign prostatic tissue.

4. Left anterior - Two tan wispy cores 3, 4mm in length and one fragment less than 2mm. A1.

- Sections show benign fibroadipose tissue.

5. Left mid - One tan core 4mm in length and multiple fragments less than 2mm. A1.

- Sections show benign fibromuscular tissue.

6. Left posterior - Three tan wispy cores 2, 3, 5mm in length and multiple fragments less than 2mm. A1. - Sections show benign prostatic tissue.

Diagnosis: 1-6. Transperineal prostate biopsies, sites as specified above - No malignancy identified.

[Tall_Allen]

I just commented on your other post.

[Vlad55 in reply to Tall_Allen]

I found your comment, thank you very much Allen

[MelbourneDavid]

PIRADS 5 is only 90% confident of prostate cancer. You are in the 10%. That right posterior lesion is too big to miss with a biopsy and was not cancer. 5 years ago I had two PIRADS 5 lesipms, both with PIRADS 5 for Extracapsular extension. One was cancer with shallow ECE. The second was a bunch of tiny non-progressing Gleason 6 spots with no ECE.

As Tall Alan said in the other group, you have usual prostate changes that are elevating your PSA. You have done the best possible investigations. It was a false positive. I think you need to now minimize the harm from the false positive by not worrying about your prostate.

Be glad - you have a non cancerous prostate and unharmed continence and sexual function.