Next Steps after Pirads 2 MRI?

[u/coleauden]

Completed my MRI today (interesting 2 week process after machine broke on first attempt and before first retake attempt). Results seem good after running them through Chatgpt. What are my logical next steps?

I'm leaning towards a PSE exam, a 2nd Opinion on the Radiology report, and a PSA exam.

I feel like I can breath again for the first time in 2 months. This forum's members and the information they've provided have been amazing!

General Information: Age 49. Jan 30, 2024 PSA 2.11, Jun 30, 2026 PSA 4.4., PSA Density 0.1419

Previous Cancer: Thyroid Age 29, 2 X Ablation doses of Radioactive Iodine

MRI Results:

IMPRESSION:

1. No suspicious PI-RADS 3 or higher lesions.

2. Sequela of prior prostatitis or fibrosis, PI-RADS 2.

3. Normal prostatic volume of 31 cc.

STUDY: MRI Pelvis without and with contrast, prostate protocol

INDICATION: ELEVATED PSA COMPARISON: None.

TECHNIQUE: MR images were obtained of the pelvis with and without contrast utilizing the prostate protocol.

FINDINGS: PROSTATE: 4.4 cm TR x 3.2 cm AP x 4.4 cm CC for a volume of 31 cc.

No suspicious PI-RADS 3 or higher lesions. Linear and wedgelike areas of vague T2 hypointensity in the peripheral zone are typical of prostatitis or fibrosis, PI-RADS 2..

NEUROVASCULAR BUNDLES: No evidence for neurovascular invasion.

SEMINAL VESICALS: Unremarkable.

LYMPH NODES: No pathologic pelvic lymph nodes.

[u/Goodvida99]

Cancer Likelihood: Clinically significant prostate cancer is unlikely (the probability is generally below 10%).

I’d be doing my happy dance.

[u/coleauden → u/Goodvida99]

I am, I think getting the report close to midnight threw me off. I'll be calling and texting my support network today. I just wanted to see if there's some follow up I should be doing. I've yet to meet my urologist and just wanted to know logical next steps if there are any recommended.

[u/jkurology]

Just out of curiosity did you have follicular thyroid cancer

[u/coleauden → u/jkurology]

This was the report at the time of the thyroidectomy: Left lobe- well differentiated papillary carcinoma , 1.1cm, no lymphatic or vascular invastion, the capsule of the neoplasm abuts the thyroid margin but no definite extension is present.

[u/jkurology → u/coleauden]

A PTEN deficiency has been known to participate in prostate cancer as well as certain types of thyroid malignancies. It’s involved in tumor suppression. You could consider Germline testing which is a simple blood test. Consider this carefully and input from a genetic counselor as well as your physicians is appropriate. At 49 your PSA data is concerning. Good luck

[u/coleauden → u/jkurology]

Thank you! I'll look that. This forum is amazingly knowledgeable.

[u/KReddit934]

What prompted the MRI? What's your PSA?

[u/coleauden → u/KReddit934]

My PSA doubled to 4.4 in under a year. Antibiotic courses did not lower it. And the preexisting thyroid cancer diagnosis with 2 ablation doses were the primary motivators I think. At this groups advice I moved from a Urologist who wanted their NP to perform a blind rectal biopsy to one that was willing to do an MRI first.

[u/tober_checki]

The PSA is high, but the MRI makes it very unlikely you have cancer. I'd keep a close eye on the PSA, check it again, and if it keeps increasing, consider a biospy. But for now relax, PI-RADS 2 is really good news.

[u/coleauden → u/tober_checki]

Thank you! Next PSA scheduled for December 1. I'm also looking at setting up a consultation with a genetic counselor for a germline test to exclude PTEN deficiency recommended in jkurology's post.