MRI report

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Can someone help me understand my husband MRI report please? 

How serious is this please

His PSA is 4.86

But the MRI report seems indicating high grade cancer and almost entire occupy the prostate?? His biopsy is not until the end of the month! so 3 weeks from now!! Waiting is killing!

He is in othewise very good health condition and 67 and his parents recently passed at age 92 and 94 so I am hoping that he inherited the family long life gene!

PROCEDURE: MRI PROSTATE W WO CONTRAST 
 
HISTORY: Elevated PSA. Most recent PSA 4.86 ng/mL on 10/24/2024.  
 
TECHNIQUE: Multi-parametric 3.0 Tesla MRI was performed using a torso phased-array coil, including multiplanar T2-weighted images, axial T1-weighted images, axial diffusion-weighted images, and volumetric dynamic post-contrast images of the prostate. Axial in-and-opposed-phase gradient-echo T1-weighted images and pre- and post-contrast fat-suppressed gradient-echo T1-weighted images of the entire pelvis were also obtained using the "Prostate with Contrast" protocol. 
 
 COMPARISON: None. 
 
 FINDINGS: 
 Prostate size: 4.6 x 3.7 x 3.9 cm for an overall volume of 35 cc. PSA density: 0.14 
 
 Tumor localization: Lesion 1 in the transition zone PI-RADS assessment category: 5, Very high probability Appearance on T2-weighted images: 5, lenticular or non-circumscribed, homogeneous, moderately hypointense, and >1.5 cm in greatest dimension, or definite extraprostatic extension/invasive behavior Appearance on diffusion-weighted images: 5, focal markedly hypointense on ADC and markedly hyperintense on high b-value DWI; >=1.5 cm in greatest dimension, or definite extraprostatic extension/invasive behavior. This lesion has a low ADC value of 0.4 Appearance on dynamic post-contrast images: Positive - focal enhancement directly corresponding to the suspicious finding with early or contemporaneous enhancement to normal prostate 
 
Size: 1.8 x 1.2 cm, series 17 image 14 (T2) 
Side: Right 
Zone: Transition 
Level of prostate: Predominantly mid gland (nearly involving the entirety of the anterior transition zone) 
Location within transverse plane: Anterior 
Extraprostatic extension: Abuts the prostatic capsule 
 
Additional peripheral zone findings: Linear or wedge-areas of decreased signal on T2-weighted imaging with associated diffuse increased perfusion, suggestive of prostatitis. Additional transition zone findings: Enlarged and heterogeneous with circumscribed nodules consistent with benign prostatic hyperplasia. 
 
Extraprostatic extension: None. 
 
Seminal vesicle invasion: None. 
 
Lymph nodes: No pelvic lymphadenopathy. 
 
Osseous structures: No aggressive osseous lesion. 
 
Additional findings: The urinary bladder is unremarkable. There is a 0.6 cm prostatic utricle cyst. 
 
IMPRESSION: * 1.8 x 1.2 cm right anterior predominantly mid gland (nearly involving the entirety of the right anterior transition zone) transition zone lesion, corresponding to an assessment category of PIRADS 5 - Very high (clinically significant cancer is highly likely to be present). This lesion abuts the prostatic capsule with a low ADC values of 0.4 suggestive of a high-grade tumor. 
 
* No lymphadenopathy. 
 
The prostate gland was segmented and the suspicious lesion(s) were annotated on the DynaCAD system for UroNav guidance. 
  • Thank you! We will definitely look into the other option as well. As far as I recall the surgeon mentioned the Brachytherapy but he does not recommened as it's not 100% of targeting the right spot. His tumor area is big. We have 2nd opinion on 3/4 with another hospital and we will definitely bring that up. Also we have already asked to make appt with oncologist. Thank you and I will keep you posted! Thank you so much guys!

  • Hi….. mmmhhhh, that’s a bit confusing as the brachytherapy treats the whole of the prostate, I have 59 of the seeds in mine and I only have a small one. Please dont think I am pushing you towards this as its a difficult choice as I was all over the place early on trying to make it, all I want to do is to just say there are other options, it might be this is not possible for one reason or not the recommended route, its just ️another consideration..   it’s a difficult time, and you are lucky in 1 way as you have options, a lot of other people don’t.   BlushSlight smile

  • Hi mine is confined but they have not offered me brachytherapy 

  • Hi, I don’t think it is offered all over the country, but worth asking their view on it, please let us know if you do ask 

  • Hello  

    they have not offered me brachytherapy 

     is right, it's not offered everywhere because not all Health Trusts have the facilities to do it - but if you want it they will tell you your nearest centre and put you in touch there.

    Best wishes - Brian.

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  • Will do the hospital are ringing me 22nd march 

  • We will definitely report back. By the way we are in US, not UK if that makes any difference. We are making appt with Radiaology oncology now. Thank you guys!

  • Bluecloud1, We thank you from the bottom of our hearts that you are sharing your experience. We definitely want to know there are more options out there. We just don't remember that this was an option offered to us when we saw the surgeon. He did mention that he will schedule us to see radiology oncology before the surgery so we have some other choices but we were not aware of this brachytherapy. Reason we are leaning towards surgery now one of the reasons is that we heard that after radiotherapy we don't have surgery option any more if recurred, also of course surgery is a complete solution as we get rid of it completely. Anyway we will keep you guys posted. Thanks!

  • Hello  

    . By the way we are in US

    I would think that Brachytherapy would be offered on you side of the pond. I would be doing my research.

    You are correct that surgery isn't possible after Radiotherapy but Radiotherapy is possible after Surgery.

    I would consider the fact that Surgery is a major operation, take into account your age and recovery time - the possible side effects and the fact that 40-45% of folk who have surgery need further treatment. Yes you do "get rid" of it with surgery BUT you need clear margins around the Prostate Bed.

    Don't forget this is only my personal opinion and not Macmillan's   - I am a wimp I wouldn't go for surgery (I was unable to have that choice anyway) and I am needle phobic too!!

    Keep doing your research and list the pros and cons of every treatment as they apply to you and your family.

    Best wishes - Brian.

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  • I have just been thinking about this and what would I want to know.. I would want to know how quickly is it likely to break out of the prostate given how much there is in there now, because in my case I was advised I had time as only 30% of one of my samples was canerous..  The reason I would want to know is because it will take time to go through the process and even then if it’s planting the seeds they don’t work immediately, it seems they peak in the 1st few months and then drop of slowly over the next 7 or so, so if the cancer grows faster than the treatment and break out of the prostate then we have lost… In my case I was advised that would not happen, so I am hoping it doesn’t….  As regards the surgery bit, I get that, however my view was this will not fail, which was quite bold for me, but that was how I felt. Only time now will tell.   We are mere amateurs here learning something we felt we would never have to, the surgeons and oncologists are experts, and we make our choices around what they say and what else we learn on top… sorry to go, I just feel what you are going through