PSA Level Concerns

Well I got to communicate with Dr. Pavlovich and he ordered a PHI test. I’m waiting on those results now. He said I don’t have an urgent situation and to let’s see what this test says.

Yes I get DRE’s and PSA every year. Dr. Pavlovich wanted to know if I ever got over 4 and so now he wants a PHI blood test done.

He gave me an MRI 2 years ago which was normal but did show my prostate was slightly on the large size at 41cc, which he said would certainly make my PSA higher.

Ok well I just got my new mri results back, would like to get opinions. I’m guessing based on this that my psa is going up because my prostate went from 41cc in 2019 to 50cc now. Waiting to hear from the doctor to see if there is a next step or what.

EXAM: MRI PROSTATE W/WO CONTRAST WITH 3D

INDICATION: Rising PSA c/w prior MRI 2019. Positive FHx prostate cancer

PSA:
- 4.7 on 1/22/2021
- 3.0 on 1/14/2019

Prior biopsy: None.

COMPARISON: 2/6/2019

TECHNIQUE:
Imaging at 1.5 Tesla performed at Johns Hopkins.
Coil: Body Matrix coil
Sequences: Large field of view images of the pelvis were obtained: 3D T2 weighted and axial T1 weighted with fat suppression after contrast administration. Small field of view imaging of the prostate was performed with axial and coronal T2 weighted
imaging. Diffusion weighted imaging (DWI) was performed 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.
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:

IMAGE QUALITY: Diagnostic.

HEMORRHAGE:
No areas of high T1 signal suggesting hemorrhage.

PROSTATE VOLUME:
Prostate measures: 5.0 cm TV x 3.8 cm AP x 5.0 cm CC, volume 50 cc.

Prostate volume calculated in DynaCAD Prostate Boundary segmentation: 49 cc

PERIPHERAL ZONE:
Diffuse mild T2 hypointensity with linear T2 hypointensity without restricted diffusion or asymmetric perfusion, which can be seen with prostatitis.

TRANSITION ZONE:
Moderate hypertrophy with heterogeneous T2-signal. No focal areas with suspicious morphology.

SEMINAL VESICLES: Normal, symmetric.

NEUROVASCULAR BUNDLES: Normal, symmetric.

BLADDER NECK: Normal

MEMBRANOUS URETHRA: Normal

LYMPH NODES: None enlarged.

BONE MARROW: Normal signal intensity.

OTHER: None


IMPRESSION:
1. No suspicious abnormality on MR imaging.

2. Diffuse mild T2 hypointensity with linear T2 hypointensity without restricted diffusion or asymmetric perfusion in the peripheral zone, which can be seen with prostatitis.

Overall PI-RADS = 2/5
Overall Follow-Up Score (PRECISE) = Stable MRI appearance: no new focal/diffuse lesions.