MRI with suspicious spots and negative biopsy

[witantric]

Just wanted an opinion. Let us say you see a high PIRAD score on MRI, but MRI-targeted biopsy is benign. Should that make you nervous? Talking to urologists at UW, Stanford, and Mayo they didn't seem that was too weird. I guess urologists believe that biopsy is the "ultimate truth".

For example, if you go on AS or "watchful mode" based on the above information and MRI keeps showing these persistent troublesome spots, should you get treatment?

I see several folks on this forum that had high PIRAD score but benign biopsies, so seems like relevant to this group.

[Tall_Allen]

I don't know why you'd think some imaging is more reliable than an actual tissue sample.

[fbrancato in reply to Tall_Allen]

It happened to me. Doctors could have not hit the correct spot on the biopsy.

[Tall_Allen in reply to fbrancato]

They take 4 cores from each PIRADS 3-5 lesion, if they miss it in 4 cores, it's probably insignificant.

[witantric in reply to Tall_Allen]

Just had a followup with my urologist. Tall_Allen is right. Here is how they sample the lesions that show up on MRI. He said that two are taken right from the "bullseye" of the lesion and two from other areas of the lesion. So the probability of missing anything is very small. At the end we are all playing a probability/statistical game.

[Murk]

I would think the only better and ultimate test is to get another MRI and Biopsy.

[witantric in reply to Murk]

Planning on that. Thanks! Your journey seems very interesting. Hope you are doing well and happy new year.

[Callbox]

This is precisely what just happened to me. MRI showed a spot that was graded PIRADS 5. Surgeon who did targeted biopsy said 98% chance it was cancer. Turned out to be benign. I was shocked.

Reason for the MRI and biopsy was because I’m high risk and my PSA was elevated to 17 in 6 months, but we now believe this was from a case of prostatitis.

As for the dark area that was seen on the MRI, doc said it could be inflammation or even something like a mole. I asked about a second opinion - He said 2 pathologists always look and that the biopsy is conclusive. And if it was his own he wouldn’t get a second opinion. So he was very certain it is not cancer. So definitely trust a targeted biopsy over MRI, as others said.

But the PIRADS 5? Doc said when you have a giant increase in PSA over a short period of time it can lead to a false positive (it’s calculated based on PSA) - so the PIRADS 5 actually has somewhat LESS chance of being cancer than a PIRADS 4. (Because the lower score would show a slower growth that is more characteristic of PC. Which is counterintuitive I know.)

My concern however is how can I proactively screen for cancer now? My father (and grandfather) died from PC in early 60s. Doc said continue to take PSA, suggested Flomax to shrink my prostate, then another MRI next year. But the drug has has some serious side effects so I’m not sure I’ll take it.

Hope this info helps. The only other advice I would offer is if you’re still worried seek advice from another doc, or have a second pathologist look at your biopsy results. Many folks here offered the John Hopkins second look option. Just go to their website.

Otherwise be grateful for the benign diagnosis as so most men here did not have that luck unfortunately.

[Callbox in reply to Callbox]

Just wanted to correct this - it was Finasteride 5mg that my doc wants me to take, not Flomax!

[Callbox]

And if you get any more advice from docs that you think are helpful in our situation please reply so I can hear it too. Good luck!

[witantric in reply to Callbox]

I have contacted three urologists now (UW, Mayo, and Stanford). The UW one did my biopsy and was extremely careful. Also, the Mayo urologist said that the UW urologist is a "rock star", so it gives me confidence that the biopsy was done carefully and by a competent person. All of them said "biopsy is the ultimate truth" and MRI only shows suspicious areas. My biopsy was targeted (4 cores from suspicious areas) plus systematic (12 cores from other areas), which seems to be standard. So the urologist who did the biopsy was very careful. Feel free to send me a private message and we can chat further.

[Starr15]

It’s not uncommon. Prostate MRI is not easy to interpret, especially in the transition zone of the prostate. If the urologist feels like they got a good biopsy of the target, that is reassuring.