What does PI-RADS 5 lesion in the prostate indicate?

Question

Hello doctor,

I am 35 years old. I developed sudden pain in my anorectal area around two years ago, and I also felt some tenderness in the prostate. However, they did not do anything as I did not have any urinary symptoms. The semen culture was fine. However, I developed urinary symptoms about one year ago, with difficulty holding urine. I also have difficulty passing stool.

Last year, I had an MRI of the prostate, which revealed some abnormality in the peripheral prostate zone, but it was nonspecific. I have pain on and off. However, recently, my MRI prostate showed a PI-RAD 5 lesion in the prostate. I am worried about it as it showed a hypointense peripheral zone and positive DCE with a 19 mm lesion.

Could you please assist me in determining what it would be? I believe it could be prostatitis.

Thanks and kind regards.

Answer 1

Hi,

Welcome to icliniq.com.

MRI (magnetic resonance imaging) showed about a 2.5 cm lesion in the prostate, PI-RADS (Prostate Imaging Reporting And Data System) 5. You had PSA (Prostate-specific antigen) last year, which showed 0.6 ng/ dl. Follow-up PSA and prostate biopsy are two important things to do now.

According to your age, prostate cancer is rare, but PI-RADS 5 needs to be biopsied. PI-RADS 1 or 2, we can observe, but 3,4, or 5 needs confirmation histology with biopsy. Ultrasound MRI fusion transperineal targeted biopsy should be done, preceded by serum PSA. To relieve urinary symptoms better, take tablet Tamsulosin 0.4 mg once at night with a water sip.

Please continue with follow-up, informing me of the PSA and the biopsy results for further management.

If you have any more queries, please let me know.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

PI-RADS 5 indicates a high possibility of prostate cancer, even if it could be prostatitis. A biopsy must be done to confirm the diagnosis. No need to worry about it, as it can be done at this stage, even if it is cancer.

Luckily, we have access to MRI, which diagnoses localized early lesions and enables us to have better chances of a cure. Just complete your assessment to confirm the problem and deal with it. Worry will not help; we hope for the best, and I want the best outcome for you. No matter what the diagnosis is, it can be dealt with.

Be strong and focused. I am here for you and will follow and give you the best advice.

If you have any more queries, please do not hesitate to contact me.

Thank you.