Follow-Up of Men With PI-RADS™ 4 or 5

[maley2711]

practiceupdate.com/C/114178...

Most men with PIRADS 5, and to lesser extent PIRADS 4, will be found to have significant cancer on biopsy. If biopsy finds nothing , then generally a followup MRI no longer finds a PIRADS 4-5. If PIRADS 4-5 continues to be found, generally a 2nd biopsy will find cancer. For men with PIRADS 2-3, 23% have positive biopsy. VERY SMALL study....but something of importance re an accurate diagnosis. One lesson...confirm that urologist takes sufficient number of samples at the initial biopsy!! at least 4 !! QUESTION: how is it that areas first designated PIRADS 4-5 are then later judged to be something else? Operator error?

[CarverD]

PI-RADS is an interpretation of images, not actual cells. Thus, it has to do with interpreting the likelihood of cancer depending on what the images show. Pi-RADS 4-5 have been found to be up to 36% benign in the peripheral zone and up to 62% benign in the transition zone. This is not due to operator error. Lesions in the prostate can be caused by things other than cancer; for example infection, inflammation, and BPH. Diagnosis of PI-RADS 4-5 is a very strong indicator that a biopsy should be preformed to examine the actual cells but by itself does not guarantee cancer.

[maley2711 in reply to CarverD]

I'll add that numerous studies that a Pirads 5 approximately double the significant prostate cancer rate...compared to PIRADS 4, PIrad 4 approx 40%, 5 approx 80%.

I have had a bad experience with PIRADS grading. One community radiologist first graded 3, so didn't feel too bad about that...20% or lower risk of significant cancer, however, the radiologist who reviewed at med school where I was to have the fusion biopsy graded a 5! I was shocked....and depressed about bad news...to make matters worse, couldn't even make a good start on the biopsy...threw in the towel from the tortuous pain just from insertion of ultrasound probe!! Now, I'll try again with sedation? I've been told less than 0.1% chance that a man won't tolerate the probe...so that made me feel like a loser and wimp!! I would like to know...why that happened for me?? Docs offered no reasons !!

[dentaltwin in reply to maley2711]

Reading images is somewhat subjective; but then again, so is histologic grading on biopsy. You need to be in a good place. And "tolerating" the probe at 99.9% means nothing if you're the 0.1%.

Honestly, my biopsy was painful, but I didn't blame myself. I blamed the urologist for his crappy anesthesia. Most people around here (certainly not all) had no major problems. Given the divergence of opinion with reading your MRI, my inclination is to find a better place--someplace with a high volume of prostate disease and good urologists and good radiation oncologists.

Good luck!