Can Anybody Interpret My MRI Results?

Just got back from my biopsy(my first fusion biopsy, not sure how many needles)and won’t have the results until after the holiday weekend sometime. Hoping I don’t worry myself to death so I’m hoping someone can understand this report. Thanks!

A lesion in the left anterior peripheral zone at the apex is at intermediate suspicion for malignancy with an overall PI-RADS score of 3. This lesion is seen only on diffusion sequence without clear T2 correlate. While best characterized as PI-RADS 3, this lesion may also represent sequelae of prostatitis.

EXAMINATION: MAGNETIC RESONANCE IMAGING OF THE PELVIS WITHOUT AND WITH CONTRAST HISTORY: Elevated PSA 7.7. Evaluate for prostate cancer TECHNIQUE: MR imaging of the prostate gland was performed with a torso phased array coil prior to and following administration of intravenous gadolinium. Protocol: Prostate 3T Contrast: gadoterate 15 mL COMPARISON: None FINDINGS: Prostate volume: 29 cc The prostate transition zone is enlarged with benign prostatic hyperplasia. Non-masslike mild T2 hypointensity within the peripheral zone likely represents sequela of prostatitis or fibrosis. The prostate was assessed using the PI-RADS version 2.1 scoring system. The following lesions are of at least intermediate suspicion (PI-RADS 3 or greater): Lesion 1: This lesion demonstrates bright signal on IV value imaging without clear correlate on ADC or T2 images. Side: left location: anterior Zone: peripheral zone Craniocaudal: apex Key images: series 10, image 51 Size: 0.6 mL; largest axial dimensions 1.5 x 1.2 cm Extraprostatic extension: - tumor contact length with prostate margin: 0 mm - margin bulge/irregularity: no - rectoprostatic angle obliteration: no - neurovascular bundle asymmetry: no - gross extraprostatic extension: no - overall EPE grade: 0 (no suspicion for pathologic EPE) T2WI score: 1 DWI score: 3 DCE: negative, hypoenhancing Overall PI-RADS v2.1 assessment: 3

Diagnosis in 2018 was Gleason 6……two of 12 needles. 30% and 15% respectively. Biopsy in 2020 was negative. Stable PSA(3-4)until this May when it jumped into the 7.7. I had my first ever gout attack two days before my blood was drawn, not sure if that matters but hoping that might be the cause of the big PSA increase.

Hello Convert - Well, you hit a holiday weekend so responses may not keep up with your anxiety.

I had my biopsy on Aug 30th, 2018 so I had to wait until after the Labor Day weekend to get any results also. The results were essentially that my urologist called and said that I had cancer and we should meet in couple of weeks to discuss the details, bring your wife. Of course, I knew it was coming from the MRI (PI-RADS 5) but nothing like hearing it from the Doc after biopsy confirmation. This was right before medical records were easy to get online so had to wait, a tough couple of weeks.

Anyways, there is nothing in the information you provided that would give you a clue to the answer. The jump in PSA could be due to a number of things and the PI-RADS 3 classification is a middle of the road observation, flip a coin. The gout attack and MRI mention of possible prostatitis could be causes of PSA. They did appear to do a targeted biopsy so the odds are good they will find something if it is there.

Try to enjoy the weekend. Worrying will not help change the results and it is what it is. I know, easier said than done but you have to try to stay cool and wait it out.

Convertible.....

I use Claude.ai, an artificial intelligence engine which is publicly available, for a host of purposes... health, recipes, diet, sports info, etc.

So I took the liberty of copying your MRI Report, and pasting it into Claude, with the question " can you interpret this MRI report for me. Then I clicked return. AI is amazing, I got an answer within less than 3 seconds. As you called it, your report indicates a "flip of the coin" result. Lots of specifics in terms of explanations in the response I received. I am copying and pasting the response below....

I'd be happy to interpret this MRI report for you. This is an MRI of the pelvis, focusing on the prostate gland, performed due to an elevated PSA (Prostate-Specific Antigen) level of 7.7, which raised concerns about possible prostate cancer. Here's a breakdown of the key findings:

Prostate Size: The prostate volume is 29 cc, which is within the normal range for most adult men.
Benign Prostatic Hyperplasia (BPH): There's an enlargement of the transition zone of the prostate, consistent with BPH. This is a common, non-cancerous condition in older men.
Peripheral Zone: There's a mild abnormality in the peripheral zone, likely due to prostatitis (inflammation) or fibrosis (scarring). This isn't necessarily indicative of cancer.
PI-RADS Score: The radiologist used the PI-RADS v2.1 scoring system, which is a standardized method to assess the likelihood of clinically significant prostate cancer.
Lesion of Interest: One lesion was identified and given a PI-RADS score of 3. Here are the details:

location: Left side, anterior part of the peripheral zone, near the apex of the prostate
Size: 0.6 mL, measuring 1.5 x 1.2 cm at its largest
Characteristics:

Bright on DWI (Diffusion-Weighted Imaging)
No clear corresponding abnormality on ADC (Apparent Diffusion Coefficient) or T2 images
Negative on DCE (Dynamic Contrast-Enhanced) imaging


No signs of extraprostatic extension (cancer spread outside the prostate)


PI-RADS 3 Interpretation: This score indicates an intermediate suspicion for clinically significant cancer. It's not clearly benign, but also not clearly malignant.

Conclusion: While there is an area of concern (the lesion), the overall findings are not definitively indicative of prostate cancer. The PI-RADS 3 score suggests that this lesion falls into a gray area where cancer can't be ruled out, but isn't highly suspected either.
Next steps typically involve a discussion with a urologist, who may recommend:

Close monitoring with repeat PSA tests and possibly follow-up imaging
A prostate biopsy for definitive diagnosis, especially considering the elevated PSA

Remember, while this MRI provides valuable information, it cannot definitively diagnose or rule out prostate cancer. The final diagnosis would require a biopsy if deemed necessary by your healthcare provider.

SS - you just have to enter your email address, thats all you need. I don't use the Pro (paid) version, the everyday free version works fine.

I've used CoPilot it is also very good.
Bard (now called Gemini) , the google AI engine, is good too, but it tends to dodge medical questions, for obvious reasons.

Always need to be careful, AI can make mistakes. But I haven't found any in Claude yet.

Did I just hit the lottery?

Diagnosis: A. Prostate, right posterior, needle biopsy - Benign prostatic tissue with acute inflammation B. Prostate, right mid, needle biopsy - Benign prostatic tissue with acute inflammation C. Prostate, right anterior, needle biopsy - Benign prostatic tissue D. Prostate, left posterior, needle biopsy - Benign prostatic tissue E. Prostate, left mid, needle biopsy - Benign prostatic tissue F. Prostate, left anterior and spot, needle biopsy - Benign prostatic tissue


Specimen(s) Received: A: Right posterior B: Right mid C: Right anterior D: Left posterior E: Left mid F: Left anterior and spot Gross Description: Received in six formalin jars labeled with the patient's identifiers. A. Labeled "right posterior" are two cores of pale tan tissue (1.3 x 0.1 x 0.1 cm each). Labeled A1. Jar 0. B. Labeled "right mid" are four cores and fragments of pale tan mottled tissue (1.5 x 0.2 x 0.1 cm in aggregate). Labeled B1. Jar 0. C. Labeled "right anterior" are two cores of pale tan tissue (1.3 x 0.1 x 0.1 cm each). Labeled C1. Jar 0. D. Labeled "left posterior" are two cores of pale tan mottled tissue (1.2 and 1.5 cm in length, 0.1 cm in diameter). Labeled D1. Jar 0. E. Labeled "left mid" are two cores of pale tan tissue (1.4 and 2.0 cm in length, 0.1 cm in diameter). Labeled E1. Jar 0. F. Labeled "left anterior and spot are three cores of pale tan mottled tissue (1.5 x 0.1 x 0.1 cm each). Labeled F1. Jar 0.

I believe there were 15 needles used and they all came back benign! Thank you to everyone who read my posts and replied. I would try to tell you how you don’t know how much it means to me but I know everyone here knows exactly how important this forum and all its supporter and participants really are. Thank you so very much!

Convertible, that sounds great. Congratulations on hitting the winning numbers. You can relax for awhile.

However, given your previous positive biopsy and your current PSA you'll want to remain vigilant. Maybe another PSA test in 6 months to see what's what.

Jim

Congratulations on getting a clean biopsy! I concur with Mumbo, you still need to be dilligent in your PSA monitoring.

Congratulations again!

Ron (Boomer)