Went To An Internist For The First Time In 10

Question : Went to an Internist for the first time in 10 years and had a 10.2 PSA. Ten years prior to that had 6.1, and free PSA 19%. Declined biopsy, and have enjoyed great health. Some frequent urination frequency. This month had Pelvic MRI, and trying to interpret, before seeing a Urologist. The MRI findings are as follows: Enlarged 4.84cm AP x 5.41cm craniocaudal by 5.33 cm transverse. On precontrast imaging in the right medial central zone there is a high signal nodule 0.57 x 0.74 cm. This nodule is not well appreciated on postcontrast imaging. On remainder of pre and postcontrast imaging there is no evidence of nodule or mass. There is no evidence of extraprostatic extension.No adenopathy,No focal wall thickening or mass, no bony lesion, or fracture. IN conclusion: Moderate enlargement of prostate. Small nodule medial aspect of the right central zone 0.57 x 0.74 on image 10 of series 3. If biopsy is contemplated , biopsy withattention to this nodule advised if clinically warranted. I have been trying to determine where on PI-RAD v2 scale is rated, and for a better understanding on what "not well appreciated may mean , and ADC. I'm not even sure if I should proceed with biopsy, as I view various statistics on expectancy with treatment vs. doing nothing. I"m in great health otherwise than these issues in allrespects. I'd like a better understanding of the Prostate Cancer probabilities, if any per the MRI, as info in weighing my future options.

Dr. Goel,

Thank you for replying to my question. I have read that prostate cancer in the central gland is somewhere in the 5% possibility range, but noting that a nodule is indicated on MRI, does that increase that possibility, or could it still be benign? What is the significance of the MRI finding statement "This nodule is not well appreciated on postcontrast imaging"? Lastly would a Urologist find me non-compliant if he suggested biopsy, and I wanted to pursue "Watchful Waiting", and would that just include noting velocity rate? I ask this only so that I may be treated for any other "Luts" possible issues at some point.
Thanks again, but if you could address these final points, it would be greatly appreciated.

Daniel Lopez