Hi Hollie995.  Welcome to the forum.

I am not a doctor and I have no medical qualifications.  I had a radical prostatectomy for early stage prostate cancer just over 10 years ago, and since then I've been involved with a local prostate cancer support group.

To the best of my knowledge, performing an MRI before biopsy is a relatively recent development and has only become widely available in the last few years. This is due to the development of the "multi-parametric" MRI (often abbreviated to "mpMRI").  Whilst I am sure that there are men who've had a suspicious lesion identified which was later proved clear after biopsy, I'm not sure that the statistics are easily available.  The relative novelty of the system would make such stats unreliable.  However, you could try conducting your own searches, being sure to include "mpMRI" as a search term.

At 0.48, your partner's PSA is very low - mine was 5.6 at diagnosis, and most men have a PSA higher than this.  This is a hopeful feature; if the diagnosis should be bad news, then the low PSA and the mass being confined to the prostate should mean there is a very good chance that it's been caught at an early and curable stage. 

If I might ask, with such a low PSA why was your partner referred at all - presumably there were other symptoms? 

Hi 

thanks for your reply 

Yes he had the urological symptoms and was given an examination. The GP found a hard nodule and referred him for bloods and MRI, and thus we are here 

Do you know what the PSA has to do with treatment plan if this is cancer, which obviously the radiologist very much felt. 
 

thanks again and I hope you are doing well. 

Hi Hollie.

I should remind you I'm not a doctor, and this isn't medical guidance - it's simply what I've learned over the last 10 years.

First, I found a recent American paper which mentions that in some particular hospital department, around 15% of men with PI-RAD score 5 (which I think applies to your partner) were found not to have cancer.  That was based on a sample of 105 men, with 16 men not having it.  All the men were treated for various conditions and a few months later their score was reduced on a follow up MRI.

So, although cancer is possible, it's by no means certain. However, in statistical terms, 105 men is a small sample so the actual rate could be better or worse than 15% - but I hope it gives you some indication and maybe some hope.

We don't know that your partner has cancer, but if he does then we know the PSA is low and MRI shows the prostate is apparently intact.  This almost certainly puts it at stage 2, which is nearly always curable with the right treatment.  The biopsy will establish the "Gleason" grade of the cancer.  This is a measure of its aggressiveness.  The Gleason grade is two numbers, both between 3 and 5.  A grade of 3+3 is the least aggressive, and 5+5 is the most aggressive.  In between, you can get in order of increasing aggressiveness: 3+4, 3+5 (rarely), 4+3, 4+4, 4+5, 5+3 (rarely), 5+4 and 5+5.  

A 3+3 may not need treatment at all.  Anything with a 4 needs to be treated but there's no harm if it's delayed for a while.  Anything with a 5 needs to be treated PDQ.

Stage 2 cancers are nearly always treated by surgery, a radical prostatectomy.  This usually carried out in a centre of excellence using a robot!  Hence a robotic radical prostatectomy.  When carried out in such a centre the risks of side-effects are low and the chance for a cure is high. 

When surgery isn't recommended due to the patient's age/health, the next alternative option is radiotherapy.  This is also intended to be curative but carries its own risk of side-effects.

Other options might include brachytherapy (radioactive "seeds"), High Frequency Focussed Ultrasound (HIFU) and others.  However, not everyone is suitable for these, and their availability varies.

Any of these treatments might be combined with hormone therapy and/or chemotherapy either before or after the main treatment.  The consultant will give the best advice.

I'm doing fine after my operation and I haven't needed any further treatment.

That's probably enough information to keep you going for now.  I advise you not to do too much Googling, and at all costs avoid US hospital websites, with the exception of Sloan-Kettering and Mayo. 

Please let us know how your partner gets on.  Good luck to you both.

Hi Telemando, 

You have been most helpful, thank you so much! 

Hello, can I please ask you.  My dad had a biopsy the other day.  His score from the mri was 4 and 5.

 His  pas is 9.23.  My concern is he raised this to his doctors last May 2020, they done a full blood test but no psa at the time.  Just worried he has had this already for at least a year and a half.

could the biopsy still come back as negative, something else?

just waiting for the results now.

many thanks

jack

Hi Finn1707.  Welcome to the forum.

Let me remind you I'm not a doctor and this is only information I've picked up over the years.

A PSA of 9.23 is still relatively low, but a PI-RADS score of 4 or 5 is worrying.  The best imformation I can find indicates maybe 15-20% of men in this position don't have cancer, but something else.  There is some room for hope, but I think it would be wise to prepare for cancer.

If it is cancer then it's probably still early and can be cured by appropriate treatment as I explained above.  However, things will be a lot clearer after the biopsy results become available, with the Gleason grade being the most significant.

Please come back if you have any other questions.

Thank you so much for getting back to me so quickly.  The waiting for the biopsy results is just torture.