MRI

[aceace12]

What is actually definition if PI-rad -3 ?

[SPEEDYX]

Lesions score 3 would indicate presence of prostate cancer are you on active surveillance...your doctor should be able to guide you as to confirmation and possible treatment

[aceace12 in reply to SPEEDYX]

i am on AS... i have been on since dec,,2018 ....biopsy showed 3 cores gleason 6,, pathologist report showed 5% of tissue had less than 5% cancer... all PSA., 4 or less, last PSA was 2.75 2 months ago

[SPEEDYX in reply to aceace12]

If not confident with your doctor a second opinion would not hurt...you seem to be at a stage that if anything progresses you can take action to control.

[aceace12 in reply to SPEEDYX]

i had my first biopsy read by 3 different pathologist ..one from here in memphis tn .. the one the doctor uses... then from harvard . the third from epstein from johns hopkins ...he is supposedly the best.... ironically all 3 reports came back different diagnosis ..... only thing they agreed on was it was low grade gleason 6 .... my doctor said was that's all that mattered ... so you can see how i feel about this... everyone 's diagnosis is subjective ... i would always recommend at least 2 opinions ,

[SPEEDYX in reply to aceace12]

I understand your frustration...I tend to do a lot of research myself in order to discuss with my MO....you have to in the end trust a physician you are comfortable with...this site also will give a wealth of info...and tall allen is the best

[aceace12 in reply to SPEEDYX]

yea i agree 100%

[Tall_Allen]

PIRADS is a scale radiologists use when analyzing an mpMRI to assess the risk of finding clinically significant prostate cancer on a subsequent biopsy.

PIRADS 3 = Intermediate suspicion -the presence of clinically significant cancer is equivocal

Clinically significant cancer is defined on pathology/histology as Gleason score ≥7 (including 3+4 with prominent but not predominant Gleason 4 component), and/or volume ≥0.5cc, and/or extra prostatic extension (EPE).

[aceace12 in reply to Tall_Allen]

would a second opinion be advisable on MRI indicating pirads 3 ? also i find it odd that gleason score of 6 in 3 cores with 5% of tissue and less than 5% cancer 18 months ago is showing pirads 3... DO you think this is normal with these number ?

[Tall_Allen in reply to aceace12]

PIRADS is about suspicion, not about what is really there. Finding a good radiologist who reads the mpMRI well is important.

[aceace12 in reply to Tall_Allen]

ok thank you very much

[maley2711]

PIRADS 3 is defined by the ratings given by radiologists to different parameters used to rate PIRADS 1-5. Different studies have shown significant cancer rates of 15-30 % for PIRADS 3 MRI visible "lesions". A biopsy is recommended for PIRADS 3 lesions. Simplifying, significant cancer generally defined as Gleason 3+4 or greater, or very high volume Gleason 3+3.

[aceace12 in reply to maley2711]

i have had one biopsy i am gleason 6 in 3 cores ....questions is this lesion related to the gleason 6 that i have already been diagnosised with .... this MRI was done so my doctor can do a fusion biopsy

[maley2711 in reply to aceace12]

This may be another reason for doing an MRI before any biopsy......removes any confusion about possibly oversampling of one area?

[aceace12 in reply to maley2711]

i agreed but my doctor for some reason wanted to do biopsy prior to MRI. he said protocol was biopsy first ..then 18 months later fusion biopsy

[aceace12 in reply to aceace12]

also strange my doctor told me they would find something on the MRI ... i guess since he already knew i had 3 cores test positive he would see at least that

[maley2711 in reply to aceace12]

Suggest a new Doc!!!! Combined standard biopsy plus fusion biopsy find 25-35% more significant cancer than does standard biopsy. Tell him that FACT and ask again why MRI not performed first???? STUPID!! My Uro didn't fight on this...but I was forced to fight the insurer in order to ahve coverage for the fusion biopsy. My 100 page fact-based appeal won the day!!!

Also, he doesn't know MRI will find something not found with standard biopsy.....stupid statement, if that is what he actually said. Find a 21st century Doc!!

[dadzone43]

Google PIRADS score.

[Hidden]

You can get a _relatively_ better view of your stage in case the mpMRI report contains the tumor ADC (Apparent Diffusion Coefficient). There are many papers trying to establish a correlation between ADC and GS. It is true that there is much overlap amid GS groups, so you probably won't end up with an unequivocal Gleason Score.

Examples (higher ADC -> lower GS):

a) Table 2 of ajronline.org/doi/pdf/10.22...

GS of 6 has an ADC range 0.659 to 1.263

b) Table I of ncbi.nlm.nih.gov/pmc/articl...

GS of 6 shows an ADC of 0.750 +/- 0.162

Note on b): In my anectodal case it was the Min value that correlated well with my final pathology report, NOT the Mean that came much higher. So, I travered all the way from 7-8 at mpMRI, 8 at biopsy and finally 9 at pathology.