I have been on active surveillance since 2016. Recently had a jump in PSA from 6.5 to 8.29. Had an MRI on Saturday and here are the results. Any thoughts or input are greatly appreciated.
Impressions
--No significant interval change in appearance of the prostate, with stable size and imaging appearance of the lesion along the left posterior peripheral zone of the apex, likely corresponding to known prostate cancer. No evidence of extraprostatic extension.
--No new dominant suspicious prostatic lesion.
--No metastatic disease in the pelvis.
--Partially visualized aneurysmal dilatation of the infrarenal aorta measuring up to 3.7 cm. Recommend follow-up CTA abdomen and pelvis for further evaluation.
PI-RADSregistered v2.1 Assessment Categories
PI-RADS 1 - Very low (clinically significant cancer is highly unlikely to be present)
PI-RADS 2 - Low (clinically significant cancer is unlikely to be present)
PI-RADS 3 - Intermediate (the presence of clinically significant cancer is equivocal)
PI-RADS 4 - High (clinically significant cancer is likely to be present)
PI-RADS 5 - Very high (clinically significant cancer is highly likely to be present
Narrative
Exam: MRI of the Male Pelvis without and with Contrast
History: 60-year-old male with Gleason 3+3 prostate cancer (left base, mid gland, apex), followed with active surveillance. Most recent PSA of 8.29.
Technique: Breath-hold and non-breath-hold multiplanar assessment of the male pelvis was undertaken using external body surface coils to assess extraprostatic disease and stage the pelvis. T1, T2, gradient echo, and steady state images were created, with and/or without fat suppression, per standardized protocol to assess tissue characteristics. These included screening images to assess the abdominal retroperitoneum and regional osseous anatomy for metastatic disease. Multiparametric assessment of the prostate was undertaken with the application of multiplanar T2, diffusion, and dynamic perfusion series in an attempt to characterize intraprostatic disease distribution and volume. Image fusion analysis and semi-quantitative review was conducted using Dyna-CAD prostate imaging analysis software.
IV contrast: 9 mL of Gadavist.
Comparison: Prostate MRI 6/24/2022
FINDINGS:
QUALITY: Adequate.
HEMORRHAGE: No evidence of hemorrhage within the prostate.
PROSTATE SIZE: Prostate measures 5.0 x 3.8 x 4.0 cm, 39 mL.
PERIPHERAL ZONE: Scattered areas of heterogeneous T2 signal hypointensity which may reflect sequela of prostatitis or scarring.
Lesion 1:
Size: 1.3 cm (10:11, 7:15), grossly stable from prior.
Location: Left posterior peripheral zone of the apex
T2: Moderate ill-defined T2 hypointensity
DWI: Moderately increased DWI, moderately decreased ADC
DCE: Positive
Prostate margin: Does abut the prostate margin
Extracapsular Extension: None
TRANSITIONAL ZONE: Central gland enlargement with changes of benign prostatic hypertrophy.
SEMINAL VESICLES: Unremarkable. Seminal vesicles are symmetric in appearance.
NEUROVASCULAR BUNDLES: Unremarkable.
BLADDER: Urinary bladder is underdistended, limiting evaluation.
LYMPH NODES: No pathologic pelvic or inguinal adenopathy.
OTHER: No pelvic free fluid or drainable collection.
VESSELS: Vascular structures of the pelvis appear patent. Partially visualized aneurysmal dilatation of the infrarenal aorta just proximal to the bifurcation up to 3.7 cm with associated moderate atheromatous plaque.
LARGE FIELD-OF-VIEW: No findings of bowel obstruction on large field-of-view imaging.
BONES AND SOFT TISSUES: Heterogeneity of the sacral marrow, similar compared to prior. No suspicious enhancing marrow signal lesions.
Active Surveillance 
Diagnosed today
What does it mean
Gleason 4+5 10/12 cores 10-95%
Advice - Surgery or Radiation?
