Friend sent me recent MRI. PI-RADS results and is asking for comment.

[WhatHump]

He’s 75 and in good health (He says he has not had a biopsy yet) Sees urologist Wednesday Thanks

Here’s the full report

EXAMINATION: MRI PELVIS WITHOUT AND WITH IV CONTRAST (MULTIPARAMETRIC PROSTATE MRI) IV CONTRAST, 2/1/2023 9:00 AM:

HISTORY: Elevated PSA

COMPARISON: None

TECHNIQUE: Multiplanar multisequence MRI of the prostate was performed including small field-of-view imaging and restricted diffusion using multiple b-values. Dynamic contrast-enhanced imaging was also performed.Semi-automated software (DynaCAD) was used as needed

RESULT:
Prostate: 

Dimensions: 4.2 x 3.1 x 4 cm corresponding to a volume of approximately 27.8 cc.

Post biopsy hemorrhage: Absent

Peripheral zone:

Lesion #1:
Location: left mid posterolateral peripheral zone
Greatest dimension: 1 x 0.5 x 0.5 cm (series:4; image:13)
T2-WI: Circumscribed, homogeneous moderate hypointense focus/mass (score 4) 
DWI/ADC: Focal hypointense on ADC and/or focal hyperintense on high b-value DWI (score 3) 
DCE: Positive 
Extra-prostatic extension: Equivocal (capsule contact > or = 1.5 cm OR capsule irregularity or bulge)
PI-RADS assessment category: 4



Transition zone: There is transition zone hypertrophy, without focal abnormalities suspicious for clinically significant disease (PI-RADS 2).

Neurovascular bundle: Unremarkable.

Seminal vesicles: Unremarkable.

Adjacent Organ Involvement: Not applicable.

Lymph nodes: No enlarged pelvic lymph nodes.

Bladder: Unremarkable.

Pelvic bones: No suspicious pelvic osseous lesions.

Other Findings: Diverticulosis.

Degenerative changes to the vertebral column

[Tall_Allen]

Let us know what his biopsy says.

[Justfor_]

According to the report there has been a previous biopsy that resulted in still detectable bleading (haemorrhage). This mudens the imaging and as a general rule mpMRI should proceed biopsy, or in the opposite case they should be spaced apart by some months so to achieve healing.

[WhatHump in reply to Justfor_]

He says he has not had a biopsy yet. I saw that too. Wondered if it was just boilerplate. My friend is smart, but uneducated, so reached out to me. (I'm dumb, but educated. 🙃)

[Justfor_ in reply to WhatHump]

If he didn't have a biopsy and the report was not flawed by some copy and paste error, ie the reader genuinely saw a "bloody" picture, than I fear that this consists a negative element. The basic idea behind all this is that cancerous lesions are distinguished from benign tissue as their blood circulation is faster. Poking holes by the biopsy needle creates routes for blood to circulate out of the normal. Lastly, was it a 3 Tesla scanner?