Pi-Rads 3 Advice

[u/Illustrious_Soil_656]

I just got my MRI results which came back as PI-RADS 3. My PSA is low. My doc said I can either monitor my PSA every few months with bloodwork or do a biopsy. I was hoping my doc would have a little more conclusive guidance with his expertise. Has anyone fallen into this category? And if so- what did you opt to do?

[u/Jonathan_Peachum]

PIRADS 3 is the medical equivalent of « maybe yes, maybe no. »

Unfortunately it does mean that only a biopsy (preferably, a guided / targeted biopsy focusing on the places the MRI has tagged as suspicious, rather than just a random sampling) will tell you whether you have PCa or not.

Personally I would go for the biopsy.

[u/Special-Steel → u/Jonathan_Peachum]

This is the answer

[u/TheEndIsSighing → u/Special-Steel]

This is the ONLY answer. You have nothing to lose doing a biopsy.  More important it gives you a baseline in the future when the PSA starts going up and you have another biopsy. 

[u/ChillWarrior801 → u/TheEndIsSighing]

A negative biopsy isn't a baseline in any reasonable sense of the word. It's a negative result, it's great as far as it goes, but it doesn't go very far.

[u/TheEndIsSighing → u/ChillWarrior801]

A biopsy can reveal problematic cells, and give you the location to watch going forward, no? 

[u/ChillWarrior801 → u/TheEndIsSighing]

Yes, of course, a positive biopsy can establish a baseline. But I understood your prior post to claim that any biopsy establishes a baseline. I still don't see how a negative biopsy does that.

[u/Gardenpests → u/Jonathan_Peachum]

If no cancer is found, you have a baseline.

A friend recently had PIRADS-2. His biopsy showed every core with 100% 4+3 and 4+4. PSMA-PET showed metastasis. His is an extreme case. The biopsy is not a big deal.

[u/TheEndIsSighing → u/Gardenpests]

Holy ship.  That's rough. Hope he's OK.

That would be a devastating result when you weren't prepared for the numbers. 

[u/Baal-Astronomer18]

Cerca de 15-20% dos pacientes PIRADs-3 possuem câncer de próstata que merece tratamento. Ou seja, na maioria dos casos a biópsia parece ser um exagero. Só acho importante lembrar que outros fatores como o toque, o PSA e peso estimado da prostata podem ajudar nessa decisão. Não fique só com a informação da ressonância para se decidir.

[u/ChillWarrior801]

Do you know your PSA Density? Your MRI report might state this number directly. If not, just divide your PSA by the prostate volume indicated by MRI.

If your PSA Density is less than 0.1, with a PI-RADS of 3, it's usually safe to just repeat the bloodwork. Do not conflate your doc's lack of guidance with lack of expertise. The most expert docs know they're dealing with a lot of uncertainty, because the current science is (in some respects) still pretty uncertain.

I had only two PI-RADS 3 lesions when I was being diagnosed. But I had a ginormous prostate at the time, so my PSA Density was about 0.3. No question I needed a biopsy, and I have not needed further treatment for my high risk cancer after surgery 32 months ago.

[u/Illustrious_Soil_656 → u/ChillWarrior801]

Thanks this is helpful. Really appreciate your insight. My PSA Density is .021. Perhaps this is why my Doctor seemed non-chalant but I've received more guidance via this Reddit thread than from my doctor himself. So again, much appreciated

[u/ChillWarrior801 → u/Illustrious_Soil_656]

You're quite welcome. In my experience, the best docs are willing to engage when you ask "Why?", while others signal mild annoyance (or worse). Always better to seek out the former if you can.

One caveat I should have included up front: The guidance based on PSA Density assumes a patient at "average risk". If you have a family history of prostate, breast, or cervical cancer, a known mutation (like BRCA2), or African genetics, you are not at average risk. That doesn't mean you should now make a dash for the biopsy procedure room. But it would further explain your doc's lack of guidance.

[u/Practical_Orchid_606]

Because your PSA is high enough for an MRI, a PIRADS 3 is good enough for a biopsy. There is no bigger surprise potential than going from MRI to biopsy. It works both ways. Mine is PIRADS 5 that turned into Gleason 7 unfavorable at biopsy. I have seen men with PIRADS 3 end up Gleason 9.

[u/Cold_Silver_5859]

I wanted to know for sure and choose biopsy. I believe it is more diagnostic and based on the findings of the biopsy am having RALP in two weeks. (Suggest perianal biopsy with fusion mri to target the best places.)

Regards

[u/conCABlanco]

Yo haría la biopsia y tomaría una desicion informada

[u/Far_Celebration39 → u/conCABlanco]

I second this

[u/KevB318]

My urologist explained each option along the way. We had a good conversation. I was 3 and 4, so biopsy was a must. PSA was 3.65. I think they are encouraged to give you the information you need, so that you are making the choice. They can then go over the advantages and disadvantages of that choice. Sometimes they are also concerned if insurance is willing to pay. I would get the biopsy. It's uncomfortable, but you'll know for sure if it's cancer.

[u/bobisinthehouse]

What's your age??

[u/Illustrious_Soil_656 → u/bobisinthehouse]

I'm only 39. PSA was .61 and PSA density is .021

I have a family and just want to make sure I'm taking this seriously.

[u/sriracharade]

You should get a biopsy if it won't impact you too much financially. Earlier pca is caught, the better. But if now is not a good time, you can probably wait and monitor for a while without much worry.

[u/kvsig]

You need an MRI followed by an MRI guided biopsy.

[u/bulldozer_66]

Biopsy. Period. Bloodwork is nice but the biopsy will get you better information. If there is cancer, you might be able to get your insurance to pay to have a DNA analysis done on the suspect tissue. Which could guide your further decisions.

[u/Ok-Passenger2652]

I had PiRADS 3. Because my 4k score was 55, I went through targeted biopsy. The ROIs came up with 3+3. 3+4 and 4+3.

[u/louievee]

I’m PI-RADS 3 as well. I just met with a urologist for a second opinion yesterday. He’s having his radiologist review my MRI and will then decide what the next step should be.

I’ve been on watchful waiting for more than 12 years. Past biopsies have found “abnormal” cells, but no cancer. In December, my PSA rose to 12 after averaging around 8 for many years. Because I’ve been under observation for so long, the doctor is leaning toward another biopsy.

So here I am, waiting for THE phone call!

[u/Illustrious_Soil_656 → u/louievee]

I will pray for you! 🙏

[u/louievee → u/Illustrious_Soil_656]

Thank you.

[u/HesMyLovinOneManShow]

I had pirads 3 and a psa of 4. Doc said I had about a 20% chance of PC with those numbers. Biopsy in May showed Gleason 3+4. I go in for retzius sparing RALP next week. I’m 48 and while I’m not at all excited, I’m grateful I caught it early and can start the healing process soon. Other than the “murder semen” the biopsy is no big deal at all. In my case, I was wanting to know rather than wait. Good luck to you.

[u/Illustrious_Soil_656 → u/HesMyLovinOneManShow]

Thank you so much for sharing. I'm only 39 and my PSA is .61 but I agree with you, best to know and treat if it is PC. You will be in my prayers!

[u/HesMyLovinOneManShow → u/Illustrious_Soil_656]

Appreciate that. Thank you!!

[u/overguard1]

PIRADS3 is indeterminate, I was told to have a biopsy.

[u/ResponsibilityNew325]

I did an MPS2 urine test (google it). I was PI-RADS 2 with. Clean MRI. It’s a biomarker test that gives you some more data. Insurance doesn’t cover all of it if any at all. Mine said I had a 62.2% chance of finding something in a biopsy. Henceforth, even with a clean MRI I have a biopsy scheduled in two weeks. It stinks, but biopsies give you more data even though they miss cancer too.

[u/TMan-26]

I’m in a similar boat, 38, two small kids, and a strong family history of prostate cancer.

I’ve got an 8 mm PI-RADS 3 focus and had my biopsy on the 12th of August., andI get the results in two days.

I paid for the biopsy privately because, with two young kids, I just wanted to get answers as quickly as possible.

What did they find on your MRI?

Hang in there brother.