MRI Results
Hello all and wishing for a Happy New Year for everyone.
64 year old. March 2022; mpMRI indicates a PiRADS 5 lesion. Lesion is 1.8 cm and prostate volume is 32.5 cc PSA level 6.8.
Two separate biopsies. One each rectal and one each perineal. Both results are Gleason 6. Results were forwarded and confirmed as Gleason 6 by Johns Hopkins.
Dec 14, 2022. PSA is 9.8.
Dec 29, 2022. MpMRI results are PiRADS5. Lesion is 2.9 cm and prostate volume is 37.4 cc.
Will be scheduled for another perineal biopsy in the coming weeks.
My question: Has anyone had similar results, and which treatment did you chose.
I know that members are not medical experts, just looking for similar experiences. Thank you in advance.
I'm 64. I had a 5.7 PSA, Gleason 6, 2.5 cm lesion and a PiRADS 5 MRI. Pretty close to yours. Due to the PiRADS 5 MRI as well as the lesion being on the large side at 2 .5 cm, the 3 doctors I met with (Oncologist, Radiation Oncologist, Urological Surgeon) all recommended treatment instead of active surveillance. After doing research and asking the doctors a ton of questions, I went with Radiation Therapy. The statistical outcomes for Gleason 6 for surgery vs radiation are the same. In my case because the lesion was contained with no apparent spread, I did not need any other hormone therapy, just stand alone radiation.
I couldn't be more pleased with the results. Almost no side effects. No ED, no urinary issues. I had my 3 month followup a month ago and my PSA dropped from 5.7 to 2.6, slightly better than expected. Do a search on this site and there are multiple people with the same issues.
As one of the moderators put it, with surgery you will have ED and incontinence that might get better with time. With radiation, you won't have ED or incontinence , but that might get worse over time.If you decide on radiation, look into the SpaceOAR procedure. According to my Radiation Oncologist, it can cut potential radiation side effects to <1% 
It is generally accepted that over time the impacts of treatment (radiation or surgery) are about the same. The latter having an instant reaction on erections and leakage. With radiation a similar outcome occurs - just later on. In fact my radiation oncologist in 2018 told me it can take 18 months to 2 years for the full effects of radiation to kill off the cancer cells ability to spread.
That said we are all different and can react differently plus there is no time clock ticking away 😀 Dennis(ProstateCancer.net Team
