MRI and Biopsy

[aceace12]

I have been on AS since Dec.2018, gleason score 6 on 3 cores, had pirads 2 on MRI... in 2022 did it all again, Pirads 3 ...biopsy showed gleason score of 6 on 2 cores... Are these the same tumors from first biopsy ?... just had MRI again its shows pirads 4.. Doing biopsy in 2 weeks ... question is ..will these be new tumors or is it showing old tumors growing ... and so on....

Thanks,

David King

[Tall_Allen]

It doesn't matter. The only thing that matters is that there is if there is no grade progression you get to stay on AS.

[aceace12 in reply to Tall_Allen]

ok thank you

[climb4blue]

Ask your radiologist to compare the prior images to the new one with specific focus on the PIRADS 4 areas, that will confirm your concern. Progression is a real thing and has been confirmed by comparing radiology reports in studies.

[aceace12 in reply to climb4blue]

ok thanks

[dms1962]

The radiology report should clearly state whether its the same or a differnent tumor and which zone it is located. I have had 4 different radioligists score a single "suspected" lesion as follows:

Rad 1)"nothing there"

Rad 2) Pirads 4

Rad 3) Pirads 3

Rad 4) Pirads 2

The Pirads score of 3 which was determined by Cleveland Clinic even made an error by scoring it a 3, when it should have been a 2 via the Pirads 2.1 scoring system. See link below for guidance on scoring in the differnet zones. I highly recommend Dr. Busch at the Busch clinic for over-reads/ 2nd opinion. He will review previous slides and take the time to show you the details scoring on the screen in a Zoom call.

radiologyassistant.nl/abdom....

[aceace12 in reply to dms1962]

thanks very good info

[NanoMRI]

I came to learn pathology and radiology findings are mere opinions - so I seek multiple opinions of these findings and then make my decisions. And I also learned, with two cancers now, these beasts do what they want despite guidelines and studies. All the best!

[aceace12 in reply to NanoMRI]

ok thanks

[maley2711]

Yes, doesn't really matter re your question. The new PIRADs 4 is more concerning, of course.

Ask your radiologist and/or urologist about locations of those biopsy sites and also the lesions found by mRI. If you undergo sedation for your next biospy( I advise, for what it's worth) aask your Doc to maximize the number of cores taken.....esspecially if you have significant enlarged prostate!!! Studies support maximizing cores as prostate size grows!

Might also consider transperineal biopsy...might need a different urolgist who has training for that.

[aceace12 in reply to maley2711]

ok thanks