Prostate MRI results - Advice appreciated

[nvidia-ati]

Hello Everyone,

I would like to provide update and seek advice since I got a Prostate MRI at Johns Hopkins a week ago. I have included links to my past post for reference:

healthunlocked.com/prostate......

healthunlocked.com/prostate...

Here is the MRI results. I have a transperineal MRI scheduled at Johns Hopkins later this month. This will be about 8 months after my initial TRUS biopsy.

What does the "HEMORRHAGE" section mean?

Any feedback and advice will be apprecaited.

MRI PROSTATE

Results

Impression

IMPRESSION:

1. No MRI evidence of suspicious focal lesion.

2. Mild BPH.

Overall PI-RADS = 2/5

Overall Assessment Categories (PI-RADS V2.1):

Likelihood that a clinically significant cancer is present based on MRI parameters

1. Very low (clinically significant cancer is highly unlikely to be present)

2. Low (clinically significant cancer is unlikely to be present)

3. Intermediate (the presence of clinically significant cancer is equivocal)

4. High (clinically significant cancer is likely to be present)

5. Very high (clinically significant cancer is highly likely to be present)

Baseline Study.

Images and interpretation personally reviewed by: Paniz Charkhchi, MD

Images and interpretation personally reviewed by: ATIF ZAHEER, MD

Narrative

EXAM: MRI PROSTATE W/WO CONTRAST WITH 3D

TECHNIQUE:

Imaging at 3 Tesla performed at Johns Hopkins.

Coil: Body Matrix coil

Sequences: Small field of view imaging of the prostate was performed with axial and coronal T2 weighted imaging, diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping. Axial T1 weighted imaging pre-contrast and dynamic contrast enhanced (DCE) imaging was performed following injection of 0.1 mmol/kg gadolinium IV. Large field of view images of the pelvis were obtained axial T1 weighted with fat suppression after contrast administration. Offline post-processing of DCE data was performed on a dedicated Invivo DynaCAD workstation to generate pharmacokinetic maps.

Post-processing: Additional post-processing of MRI data was performed on a separate DynaCAD workstation, to include volumetric segmentation of the prostate (DCAD Prostate Boundary).

FINDINGS:

HEMORRHAGE:

Increased T1 signal consistent with hemorrhage, limiting the evaluation.

PROSTATE VOLUME:

Prostate measures: 5.1 cm TV x 3.5 cm AP x 5.7 cm CC, volume 53 cc.

Prostate volume calculated in DynaCAD Prostate Boundary segmentation: 50 cc

PERIPHERAL ZONE:

Symmetric high signal on T2-weighted imaging with no restricted diffusion or asymmetric perfusion. Few linear areas of low signal likely representing scarring.

TRANSITION ZONE:

Mild hypertrophy with heterogeneous T2-signal.

SEMINAL VESICLES: Normal, symmetric.

NEUROVASCULAR BUNDLES: Normal, symmetric.

BLADDER NECK: Normal

MEMBRANOUS URETHRA: Normal

LYMPH NODES: None enlarged.

BONE MARROW: Normal signal intensity.

[Tall_Allen]

It's a really good report, congratulations! The "hemorrhage" means that the MRI was too soon after your biopsy, so the remaining dried blood obscured your prostate. You should have been put on active surveillance with an mpMRI (and possible biopsy) in about a year. It confirms AS as the best protocol for you.

[nvidia-ati in reply to Tall_Allen]

Thanks so much for your comments, Tall_Allen. I was hoping 8 months after the initial TRUS biopsy was enough for my prostate to heal. Does this mean the MRI might be providing limited or misleading information because the blood obscured my prostate? The report did not mention what percentage of the prostate was obscured.

Is delaying the biopsy warranted?

[Tall_Allen in reply to nvidia-ati]

It's warranted for at least a year.

[janebob99]

Here's a plot of all-cause death probability versus time for different PSA doubling times. Clearly, if the doubling time is less tha 3 months, there is a fast growing prostate cancer. As a warning sign, I would start to be concerned if the doubling time drops below 8-10 months.

Bob

PSA doubling time

[SherpaT in reply to janebob99]

janebob,

I don't understand the value off the PSA doubling time. My PSA hovered around 4 about four years, then (6 month intervals) 5.8., then 5.3, then 5.0, and last one in February was 5.3. Meanwhile I went from Gleason 6, to 3+4 in 1 core a year ago, then 4+3, 1 core, 3+3 1 Core and "focus of intraductal" in 3 cores in December, which motivated me to give up on AS. My PSA doubling time would be very low overall, so how does this help? I noted on my last PSA that the range at the lab for normal changed to 6 instead of 4. If I had never gone for a biopsy 5 years ago I would not even be sent for one base on my current PSA?

Thanks for any clarification

[janebob99 in reply to SherpaT]

Hi, SherpaT.

You're in great shape, PSA-wise. Your doubling time is basically infinite because your PSA is essentially constant, 5-6. In my case, my PSA went from 5 to 10 over a period of 8 months. Then, an MRI showed a 1.3 cm long tumor in the peripheral zone (PIRADS 5). So, there was a a good correlation between the short PSA doubling time and MRI results. A biopsy confirmed 4 cores of 3+4 and 1 core of 4+3.

I don't know anything about "focus of intraductal". Perhaps Tall_Alan could explain...

The high end of the normal range of PSA goes up with age (see chart). Perhaps that's why they say your normal limit is = 6. How old are you?

So, I think you are Favorable Intermediate Risk (FIR). What kind of treatment are you thinking of, if you're going off of AS? Have you had an MRI? That would be the next step, before doing another biopsy.

You may want to type your numbers into the MSK Nomogram to get an estimate of your risk. mskcc.org/nomograms/prostat.... It's easy to use.

Bob

Normal Limit of PSA vs Age

[Derf4223]

For the bazillionth time, PSA is not cancer. Biopsies and PSMA/PET-CT scans are far more definitive.

[SherpaT in reply to Derf4223]

I never thought that. My question was regarding doubling time and its usefulness and correlation to diagnosis.