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RADS score of 4 (Prostate) - Wise to get another opinion?

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I just went to the hospital (well known government one in Korat) after an MRI session last week. The doctor said I have a RADS 4 score lesion that needs a biopsy and I have been booked in for a night and then the op the following day. Just wondering, from those who have been through this or know given their medical background, whether I should just trust the diagnosis and proceed, or whether it would be wise to postpone until a second opinion is obtained. Would need another MRI session somewhere else and delay, which if I do have prostate cancer would probably not be a good idea. Feedback would be appreciated. Thank you.

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29 minutes ago, Korat88 said:

I just went to the hospital (well known government one in Korat) after an MRI session last week. The doctor said I have a RADS 4 score lesion that needs a biopsy and I have been booked in for a night and then the op the following day. Just wondering, from those who have been through this or know given their medical background, whether I should just trust the diagnosis and proceed, or whether it would be wise to postpone until a second opinion is obtained. Would need another MRI session somewhere else and delay, which if I do have prostate cancer would probably not be a good idea. Feedback would be appreciated. Thank you.

Always get a second opinion, and do not tell the second specialist what the first said. given what the hospital said, you need to look for a specialist, it might help if you say where you are, as it is the doctor/specialist that matters more than the hospital, hopefullt Sheryl is about

Edited by howerde

  • Author
16 hours ago, howerde said:

Always get a second opinion, and do not tell the second specialist what the first said. given what the hospital said, you need to look for a specialist, it might help if you say where you are, as it is the doctor/specialist that matters more than the hospital, hopefullt Sheryl is about

Thanks for the lone reply howerde. I am in Korat, hence my user name, but can travel to BKK if necessary. I am thinking of going to BKK Hospital in Korat for a second opinion. Believe the cost is in the range 15,000-25,000 Baht. Will check for certain today.

I would come to Bangkok, hoping that someone will recommend , but i always go to to the hospital website and choose the doctor from their bios, me a minimum english and have trained or practised in a western country, and that they have kept up to date with latest developments their bios show further development,

https://www.bumrungrad.com/en/centers/urology-prostate-bladder-center-bangkok-thailand

reasearch your doctors i am not recomending Bumrungrad though it is my hospital, i would look at other hospital websites and do the same, there are world class doctors and specialists but you need to find them,

The above hospital i have found the doctors at consultation not bad it is the tests that cost, i have found that looking for a doctor who is not full time in the hospital the best, thay will work in the government scheme and have evening or weekend clinics at various hospitals, when i saw one for burns on my feet, he told me to gets the tets from a clinic and email them to him(at the hospital would have been about 30 000, but you have to ask

Edited by howerde

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First of all, you do not have a diagnosis yet. You have a score which estimates risk based on radioligic findings.

What type of MRI did you have? Was it s Multiparametric prostatenMRI? Usually not avaiĺlable in upcountry govt hospitals.

IF you had an MP-MRI then you have a PI-RADS score not a RADs score.

Please clarify. I suspect you did not have MP-MRI. Hard to get outside of Bangkok.

Note that if you do need biopsy it dhould be done under MRI/ultrasound fudion. Also not widely available outside of Bangkok.

best to come to Bangkok, better specialists and technology.. I recommend this doctor;

https://www.medparkhospital.com/en-US/doctors/assoc-prof-dr-sittiporn-srinualnad

https://www.siphhospital.com/en/medical-services/doctor-biography?id=246

He is also at Bumrungrad but more expensive thetr.

And at Thonburi Hospital but their website serms to be acting up. Thonburi is actuslly best place to see him in terms of speed and cost but it is on the other dide of the river so manyvpeople find it less convenient location. Especially if relying on public transporyt. Same is true of SIPH (Siriraj), location-wise.

P

I had a similar score several months ago and plan to get another MRI at another provider. A number of factors went into this decision. My PSA density was on the low to moderate side which I think is moderately encouraging. If biopsy procedure results in a low grade cancer diagnosis, they might just recommend active surveillance (regular testing but not immediate surgery). If surgery were indicated I would have second thoughts due to the potential side effects. With other health and personal issues it was more than I was able to deal with and the doctor said it would be okay to take some time to think about it all.

  • Author

Thank you again howerde, and also Sheryl and InlandSea. I don't know the specifics of the MRI, and yes, I am also thinking of postponing the surgery which is planned for 26th to get other opinions. BKK Korat (surely they have a MP-MRI even if upcountry as they are part of the BDMS group) are quoting 15,000 Baht for a session, but I have to see a doctor first to see whether they agree I need it. The other hospital has already done the MRI and booked the surgery.

Just now, Korat88 said:

Thank you again howerde, and also Sheryl and InlandSea. I don't know the specifics of the MRI, and yes, I am also thinking of postponing the surgery which is planned for 26th to get other opinions. BKK Korat (surely they have a MP-MRI even if upcountry as they are part of the BDMS group) are quoting 15,000 Baht for a session, but I have to see a doctor first to see whether they agree I need it. The other hospital has already done the MRI and booked the surgery.

I doubt Bkk Hospital Korat has an MP-MRI. Being part of the same group in no way means having the same technological capacities as the main branch, this is a common misunderstanding. Doctor expertise also is in no way comparable between upcountry affiliates and main Bangkok hospital.

Please ask specifically.

There is a world of difference in capacities upcountry vs Bangkok. You should come to Bangkok as previously advised.

No idea what the "15,000 baht per session" you refer to is. Cost is way to high to mean consultation and too low for a biopsy.

  • Author

Appreciate the feedback on hospitals and equipment Sheryl. Makes sense. I checked the website and AI for the hospital I visited and results state "fully digital, high-field MRI diagnostic scanner". So not MP-MRI as you thought it would seem.

The 15,000 BHT is for a session on the Bangkok Hospital MRI here for a second set of data to study and reach a conclusion. Doctor's fee is 1,500 BHT on top of that charge.

I assume Bumrungrad, Samitivej, and other large hospitals are the ones to consider.

55 minutes ago, Korat88 said:

Appreciate the feedback on hospitals and equipment Sheryl. Makes sense. I checked the website and AI for the hospital I visited and results state "fully digital, high-field MRI diagnostic scanner". So not MP-MRI as you thought it would seem.

The 15,000 BHT is for a session on the Bangkok Hospital MRI here for a second set of data to study and reach a conclusion. Doctor's fee is 1,500 BHT on top of that charge.

I assume Bumrungrad, Samitivej, and other large hospitals are the ones to consider.

What do you mean by "second set of data "? Repeating ssme tests already done? Why do that?

In Bangkok, the hospital is not what to go by, choose the doctor. I have alrealady provided suggestion of Prof. Sittiporn Srilunuad with link. Unless you will have a car and don't mind being on Thonburi side of river, I would see Prof. Sittiporn at MedPark. If you will have a car then csn save a bit bring treated by him at Thonburi Hospital instead but you'll need to csll them as their website seems to be acting up. MedPark is quite easy to desl with both online andvby phone.

  • Author
19 minutes ago, Sheryl said:

What do you mean by "second set of data "? Repeating ssme tests already done? Why do that?

In Bangkok, the hospital is not what to go by, choose the doctor. I have alrealady provided suggestion of Prof. Sittiporn Srilunuad with link. Unless you will have a car and don't mind being on Thonburi side of river, I would see Prof. Sittiporn at MedPark. If you will have a car then csn save a bit bring treated by him at Thonburi Hospital instead but you'll need to csll them as their website seems to be acting up. MedPark is quite easy to desl with both online andvby phone.

Sorry should be "another set of data" as from what I understand hospitals in general want their own MRI departments to provide date for them to look at and ask questions about if needed. They don't like 3rd party data for a number of reasons. First I need a check-up by another doctor to see what they say. Thank you for your suggestion. I will check it out and update here in due course for others to follow, One or two may be interested.

3 hours ago, Sheryl said:

First of all, you do not have a diagnosis yet. You have a score which estimates risk based on radioligic findings.

What type of MRI did you have? Was it s Multiparametric prostatenMRI? Usually not avaiĺlable in upcountry govt hospitals.

IF you had an MP-MRI then you have a PI-RADS score not a RADs score.

Please clarify. I suspect you did not have MP-MRI. Hard to get outside of Bangkok.

Note that if you do need biopsy it dhould be done under MRI/ultrasound fudion. Also not widely available outside of Bangkok.

best to come to Bangkok, better specialists and technology.. I recommend this doctor;

https://www.medparkhospital.com/en-US/doctors/assoc-prof-dr-sittiporn-srinualnad

https://www.siphhospital.com/en/medical-services/doctor-biography?id=246

He is also at Bumrungrad but more expensive thetr.

And at Thonburi Hospital but their website serms to be acting up. Thonburi is actuslly best place to see him in terms of speed and cost but it is on the other dide of the river so manyvpeople find it less convenient location. Especially if relying on public transporyt. Same is true of SIPH (Siriraj), location-wise.

P

Depends if you're self-pay. MP-MRI is available at King Chulalongkorn Hospital. Sirirat is also a govt hospital. Of course, seek a second opinion.

Sheryl, other than diagnosis, what treatments would you recommend for prostate cancer? As I understand it, you can live with prostate cancer a long time. I

f prostate hypertrophy compresses the urethra, making voiding difficult to impossible, then surgery is recommended.

Very few docs in Thailand, including those in the provinces, don't speak English.

If he gets a printout or disc of his RADS result, why would any other hospital not accept it?

Edited by unblocktheplanet
add

25 minutes ago, unblocktheplanet said:

Depends if you're self-pay. MP-MRI is available at King Chulalongkorn Hospital. Sirirat is also a govt hospital. Of course, seek a second opinion.

Sheryl, other than diagnosis, what treatments would you recommend for prostate cancer? As I understand it, you can live with prostate cancer a long time. I

f prostate hypertrophy compresses the urethra, making voiding difficult to impossible, then surgery is recommended.

Very few docs in Thailand, including those in the provinces, don't speak English.

If he gets a printout or disc of his RADS result, why would any other hospital not accept it?

He did not have an MP-MRI and it is not available in his province. He is not in Bangkok.

Nowadays the term "clinically significant" cancer is used to distinguish between slow growing prostate cancers and more aggressive ones. It is not the case that one can always "live with prostate cancer a long time". There are slow-growing, non-aggressive prostate cancers for which this is true but there are also more aggressive forms that advance quickly. Prostate cancer remains the second leading cause of cancer death in men in many countries. And it is a dkfficult death (metastases to bone).

Treatment of prostate cancer depends on how aggressive it is and the stage. The patient's age and overall state of health are also factors.

In OPs case it is not yet known if he has cancer. He needs to get an MP-MRI and, depending on results, possibly a biopsy. This will determine whether or not he has cancer and, if so, how aggressive it is. If it turns out he has cancer, additional scans to check for metastasis may be advised.

On 5/21/2026 at 9:03 AM, Korat88 said:

I just went to the hospital (well known government one in Korat) after an MRI session last week. The doctor said I have a RADS 4 score lesion that needs a biopsy and I have been booked in for a night and then the op the following day. Just wondering, from those who have been through this or know given their medical background, whether I should just trust the diagnosis and proceed, or whether it would be wise to postpone until a second opinion is obtained. Would need another MRI session somewhere else and delay, which if I do have prostate cancer would probably not be a good idea. Feedback would be appreciated. Thank you.

Went through the same thing.....started with a bladder infection, Ultrasound scan, PSA tests increased from 6 to 8 in a week, MRI (level 4 cancer), biopsy required.....the lot......and I'm not convinced it wasn't all a con.

Just before the biopsy the surgeon said something strange (strange to me at least).........you never know, could be benign.

Sure enough benign, an indeterminate non-cancerous lesion.

This was six years ago....every PSA since has been below 1.6.

By pure chance had a prostate examination just yesterday in the UK......smooth, no noodles, slightly oversize.

MRI etc was all in Bumrungrad......fat end of 200,000 Baht.

42 minutes ago, MIke B Bad said:

Went through the same thing.....started with a bladder infection, Ultrasound scan, PSA tests increased from 6 to 8 in a week, MRI (level 4 cancer), biopsy required.....the lot......and I'm not convinced it wasn't all a con.

Just before the biopsy the surgeon said something strange (strange to me at least).........you never know, could be benign.

Sure enough benign, an indeterminate non-cancerous lesion.

This was six years ago....every PSA since has been below 1.6.

By pure chance had a prostate examination just yesterday in the UK......smooth, no noodles, slightly oversize.

MRI etc was all in Bumrungrad......fat end of 200,000 Baht.

Cost and what any outcome or potential procedure may mean in my late fifties is partly why I didn't go straight to get the biopsy (but will likely get another MRI in about six months from the first). My MP-MRI was done after a 5.8 PSA went down only to a 4.5 with two weeks of medication and I had no other symptoms. I got a likely PIRADS 2 and a 4 with overall PI-RADS 4. The doctor recommended a biopsy but said active surveillance was often what is done even if cancer is found. I'm still thinking about what to do, but my current plan is to get another MRI at a different hospital at the six month mark and then decide.

9 minutes ago, MIke B Bad said:

Went through the same thing.....started with a bladder infection, Ultrasound scan, PSA tests increased from 6 to 8 in a week, MRI (level 4 cancer), biopsy required.....the lot......and I'm not convinced it wasn't all a con.

Just before the biopsy the surgeon said something strange (strange to me at least).........you never know, could be benign.

Sure enough benign, an indeterminate non-cancerous lesion.

This was six years ago....every PSA since has been below 1.6.

By pure chance had a prostate examination just yesterday in the UK......smooth, no noodles, slightly oversize.

MRI etc was all in Bumrungrad......fat end of 200,000 Baht.

You did nto get a "level 4 Cancer " result on MRI. Probably a PI-RADS 4. Entirely different. It just means there is a 35 - 55% chance of cancer. In other words, about half the time, people with that result do not have cancer.

MP-MRI cannot diagnose cancer, only provide an idea of the likelihood. It is used to determine whether or not to proceed to biopsy; it is the biopsy that is definitive. The value of the MP-MRI lies in reducing the number of unnecesessary biopsies. Reducing, not totally eliminating.

No "con" at all. Though with PSA of 8 and known infection, might have waited a bit first to see if treatment of infection reduced PSA before moving on to MP-MRI.

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[quote]

...

By pure chance had a prostate examination just yesterday in the UK......smooth, no noodles, slightly oversize.

[/quote]

Very reassuring that no 'noodles' were found lol.

A few years ago I had a raised PSA of 14. An MRI at Bumrungrad gave a diagnosis of likely prostate cancer, with a 4/5 likelyhood.

Due to some insurance problems, I returned to the UK for the biopsy, and that 24-needle biopsy found zero cancer cells and 2 benign calcium lumps in my prostate, with their presence and a UTI causing the raised PSA.

Nowadays, my PSA is about 8 (but steady), and increasing to 14 when I get a UTI, which is quite often. I have a PSA about every 6 months and it never goes above 14 with UTI. I'm happy...

My PSA has been between 4 and 5, I have recently started eating a lot of tomatoes and tomato sauce and taking a lycopene supplement and it is now closer to 4.

My doctor says if it is consistently 5, tested every 3 months, that I need an MRI.

But I see people here with much higher PSA levels.

Is my doctor overly conservative?

On 5/22/2026 at 4:42 PM, InlandSea said:

My MP-MRI was done after a 5.8 PSA went down only to a 4.5 with two weeks of medication and I had no other symptoms

The urologist at Naresan University Hospital prescribed Finisteride five years ago after an ultrasound showed my prostate to be 93 ml. My PSA is in the lower range, but Iwas not told that if a patient is on Finisteride, then the PSA should be DOUBLED. Never had a finger up me bum ever!

My nocturnal urinations have been stopped by my taking turmeric/ginger/cider vinegar, soda bic, honey, lemon juice on wake up and before kip. It works for me. I stopped the Finisteride as it affected my libido. Back to normal now, well normal for a 78 year old.

4 hours ago, cdemundo said:

My PSA has been between 4 and 5, I have recently started eating a lot of tomatoes and tomato sauce and taking a lycopene supplement and it is now closer to 4.

My doctor says if it is consistently 5, tested every 3 months, that I need an MRI.

But I see people here with much higher PSA levels.

Is my doctor overly conservative?

More info please:

  1. How old are you?

  1. Do you have known BPH (benign enlargement of prostate)?

  1. Was free PSA/PSA ratio done? With what result?

  1. When you say "has been between 4 and 5" -- for how long, and what was it prior to that (i.e. how rapidly did it reach this level)?

  2. Has infection been ruled out?

  1. Is doctor proposing MP-MRI/is that available where you are?

5 hours ago, cdemundo said:

...

But I see people here with much higher PSA levels.

Is my doctor overly conservative?

I'm no doctor, but I guess it depends on whether your PSA number is steady and not increasing.

BPH will cause a higher PSA value (but not 'through the roof') - I have mild BPH for decades

A UTI will cause a higher PSA value - I have regular E.Coli infections and that increases my PSA number while that UTI exists.

I know from PSA tests over the years that a 'normal' PSA value for me is about 8, increasing to about 14 when I have a UTI. The biopsy that I had a couple of years ago found no cancer, but did find 2 benign calcium stones that happily 'live' in my prostate and contribute to this increased but steady PSA value.

22 hours ago, Sheryl said:

More info please:

  1. How old are you?

    71

  1. Do you have known BPH (benign enlargement of prostate)?

    yes

  1. Was free PSA/PSA ratio done? With what result?

    I don't know

  1. When you say "has been between 4 and 5" -- for how long, and what was it prior to that (i.e. how rapidly did it reach this level)?

    For about two years, before that I wasn't aware of the PSA level.

    checked 3 or 4 times a year with no rapid increase.

    The last 9 m0nths it decreased from 5 to just over 4, this was the interval when I started trying to supplement with lycopene, coincidence possibly.

  2. Has infection been ruled out?

Yes.

  1. Is doctor proposing MP-MRI/is that available where you are?

I think so, he just says "MRI" this is at Bhumirajanagarindra Kidney Institute Hospital

A stable PSA of 4-5 in a 71 year old with BPH is pretty common. I would say your docotor is showing an abundance of caution in suggesting MP-MRI if PSA is 5 at your age in absence of sharp increase.

By all means get another opinion before investing in an MRI, unless your PSA rises further e.g. say 6 or more.

In the meantime it would be very helpful to get the free PSA/total PSA ratio as this can be very helpful in distinguishing effects of BPH from other causes of elevation. As it sounds like you are scheduled for a repeat PSA at this hospital in a few months, you could specifically request this at that time. A value of around 25% or more makes prostate cancer much less likely. While average PSA levels do rise with age, in men without cancer the ratio stays pretty constant.

  • Author

Update - Visited MedPark (most convenient location) and met Prof. Sittiporn Srilunuad (PSS). He performed the digital rectal examination which was quite uncomfortable to say the least and on completing it I was surprised when he stated I had cancer. He seemed pretty confident and so I "quizzed" that with him and he just looked at me without saying anything else. Then as I left I said I hoped the results of the MP-MRI and no doubt biopsy that has to follow would prove it is benign and he said "me too". So, not sure how anyone, even with great experience can be apparently so confident (AI searches would indicate nobody can be without the MRI and biopsys), so I guess I just have to go through the next steps and hope the news is good. For those interested, an MRI at MedPark is just under 45,000 Baht. PSS also recommended contacting Chulabhorn Hospital for a lower MRI cost when I asked for options, and he was correct with a total including hospital add-ons (MedPark price does NOT include these) of 15,600 Baht. The catch? I have to wait till September to get an appointment! So will just have to take the hit and pay the MedPark bill as waiting more is probably not a good idea.

"...I was surprised when he stated I had cancer."

Yep, that's what the doctors at Bumrungrad told me after my MRI and finger up the bum. "I can feel 2 cancer tumours with my finger" said the doctor.......

After a trip back to the UK and a a 24-needle biopsy (not painful) at an NHS hospital, the doctor found no cancer at all, just 2 benign calcium lumps....

That very experienced Indian doctor initially looked at my MRI scans provided by Bumrungrad and said he didn't think it was cancer. He told me that most biopsies that he performs found no cancer.... so don't assume the worst yet!

Edited by simon43

I usually go to the University Hospital for my tests and urologist visit. But I would have to wait 3 weeks for an appointment. So, I wwent to Bangkok Hospital here in Phitsanulok today.

10am take blood, results in 2 hours so a trip to Makro for some 0% Heineken. Back to the Doc who reviewed all previous paperwork. Stuck his finger up my bum for 10 seconds and said all was OK. PSA was 2.6, and this Doc actually told me what I knew, that Finisteride knocks 50% off PSA, so really it is 5.2, which is still acceptable. Cashier desk, I asked for Thai price, not falang, so paid 2000 not 3000 because I had a Pink Card. All in all a very satisfactory experience. I stopped the Finisteride two months ago because of side effects. Doc said that's OK.

On 5/22/2026 at 3:37 PM, MIke B Bad said:

By pure chance had a prostate examination just yesterday in the UK......smooth, no noodles, slightly oversize.

I see ads on UK telly now saying that the NHS is recommending all men over 60 should go for PSA test, and one for a Prostate Cancer Specific company says book an appointment a s a p. And that Black men should go earlier (Does Black include Asians or just Negro men)? Money, money, money!

Do they not know that the PSA test is quite unreliable, many false positives.

  • Author

Further update: VERY pleased to say that MP-MRI (cost me just over 40,000 Baht in the end) produced an "overall PI-RADS category 2 result". So I am very grateful that was the result, and for those who recommended I cancel my biopsy in Korat after the RAD 4 result on their machine, thank you. Will have another appointment with Prof. Sittiporn Srilunuad in 6 months to check my PSA again, which when just tested was at 3.94 which was also down from both the previous tests conducted on me. A friend suggested I take "Prostate Plus Health Complex" (saw palmeetto with zinc, lycopene, pumpkin seed & Cran-Max®) capsules that have helped him with prostate issues over the years. Think I will try them too.

Many thanks, as usual, go out to Sheryl who is a font of knowledge and provodes valuable health guidance to many here. Much appreciated.

  • Author

On 6/4/2026 at 3:03 PM, simon43 said:

That very experienced Indian doctor initially looked at my MRI scans provided by Bumrungrad and said he didn't think it was cancer. He told me that most biopsies that he performs found no cancer.... so don't assume the worst yet!

Thank you Simon. Your post helped a lot before I received the results. Glad all worked out well for you too. Hope your words help others in future.

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