Hello. I’ve posted before here https://www.reddit.com/r/ProstateCancer/s/MnlJpNPoMg and here: https://www.reddit.com/r/ProstateCancer/comments/1s0kf2k/update\_seeking\_experiences\_on\_surgery\_vs/
Comments have been super helpful, thank you again.
Posting with new updates and some questions.
First this is my profile: 54 years old, Vienna, diagnosed January 2026. Gleason 6 (3+3), ISUP Grade Group 1, 8 of 12 cores positive, average core involvement 89.6%, PSA 7.12, PSA density 0.29, PIRADS 5 on MRI with suspected extracapsular extension, clinical stage cT2b. Initially placed on active surveillance, subsequently seen by the head of urology at AKH who recommended intervention.
New things:
Prolaris genomic result this week came at 3.7 which is at the threshold of aggressive cancer. A repeat MRI last week showed that the main PIRADS 5 lesion is stable. But - they found a new PIRADS 4 lesion, posteromedial, near the base, measuring 8mm. My January biopsy of the left side showed only PIN. So this lesion either was not present in December or was below imaging detection threshold and has now become visible. Its been given a PRECISE score of 4 meaning probable radiological progression, specifically because of this new contralateral finding. The seminal vesicles and neurovascular bundle are described as unremarkable.
So I have gone from one large right-sided PIRADS 5 lesion to that plus a new left-sided PIRADS 4.
I have some questions, but essentially it’s been a rollercoaster and I’m freaking out a bit. I’ve moved from Gleason 6 and AS to this situation. I see the first of a series of doctors next week. A PET scan has been booked for later in May. I will see also a radiation oncologist.
These are the questions:
Has anyone had a similar experience of a new lesion appearing on repeat MRI?
The doctor was initially optimistic about left side nerve sparing. Now I don’t know. NO question there, just a bit of freaking out 🙂
Also - what’s the questions I should ask a radiation oncologist? Does having two lesions on two sides of the prostate make a case for radiation over surgery as nerve sparing may be difficult ?
Thank you for taking the time to read.