Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. You feel healthy, you arent in pain, you After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. THANKS! Surabhi Dangi-Garimella, PhD. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. Background: In the mean time my PSA was movingno longer static, but never back up to 6. 1. -------------------------------------------------------- My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Good Luck and God Bless everyone. According to the study, one in every 600 diagnoses showed mistakes.This study only addressed major changes in diagnoses, such as a diagnosis of cancer being reversed to no cancer, says Johns Hopkins pathologist George Netto, M.D. Their opinions are widely held to be definitive. focal peripheral zone lesions. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. Right mid anterior transition zone (PIRADS 2). 2. He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms. One of the problems with second opinions is that insurers may not cover the expense. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Are considering a treatment that involves significant risks, such as surgery. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Especially opinions other than those of the first Urologist you see. Benign Processes: Not all cancers are the same and not all treatment plans are absolutely clear. decision on a single medical opinion or the first appointment you get, you may Second opinions offer different things in different circumstances, Dr. Matasar says. PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Medical record collection from doctors and hospitals. I've tried to find out about Dr. Wong but there's very little info on him. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Anyone with insight into this and advice? Comments appreciated, Possible additional organ confined malignant lesion in right apex :) Good Morning Brothers- AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Here's what JH says (same lesion). I certainly would - after all, there's a certain brotherhood bond here. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. 9: Prostate, left anterior MRI lesion My questions are: It would be more convenient to use Mayo but I want the best practitioner regardless. 5. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. And just this week, 1 YEAR post treatment, it is .46. Patients may experience a fever or chills as a result of the infection. Dr. Dan Sperling - New York. Atrophy I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. Yet none of my doctors ever mentioned it! He was right. Benign prostatic tissue My question is--what importance do volume levels play in determining when to move from AS to treatment? 2. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. Thank you! Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. Consult Fees In some cases, additional testing may be required. Are you sure you want to block this member? 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. Secondary Gleason grade: 3 Find more COVID-19 testing locations on Maryland.gov. My new Dr however didnt order PSA so I asked him for one. But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. PROSTATE LESIONS: have no symptoms, and yet you have cancer? Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. Surgery took about 3 hrs. I am 58 and in very good health otherwise. I don't know if the FLA could affect the results, or if it was just done because it was not in the study parameters of the test. Video consultation and written report from your expert. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? An accurate diagnosis is essential to ensure the most effective treatment. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. For cancers that are less common, second opinions can offer more treatment options. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. First 6 week PSA is undetectable. !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. My plan is to choose quality of treatment over cost of the treatment. Can it be salvaged or are the risks of cancer too high? He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Hello everyone. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. Metastatic disease considered less likely for this pattern. The issues in my prostate from the first procedure onward have all been in the same area and the rest of my prostate from the first biopsy and subsequent MRIs onward have never shown any indications of cancer in other areas. Y'all are in my prayers! I made the appointments. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. However, something is driving my PSA. Urology. I retested in January 2019 and scored 4.20. I was on disability from work the entire time (not that I was disabled, but as a pilot, I couldn't very well work and get treatment at the same time. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. We are vaccinating all eligible patients. Y'all are in my prayers! Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. My prior Prolaris study (2018) before the FLA was very low risk. Because every patient is different, there are several ways to approach prostate cancer treatment. Obtaining a second opinion in Pathology can in a small percent of cases lead to a complete change in diagnosis in a wide range of conditions including non-cancerous growths, inflammatory disorders, infections, and cancer. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 1 of 2 cores (lateral core: 4 mm, 35%), 0.1 mm to the blue inked tissue edge However, there were no other suspicious areas on MRI. When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. Instead, I did my homework. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. Thanks! They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. Your doctor is not sure what is wrong with you. -------------------------------------------------------- He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Prostatic Adenocarcinoma Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. 1. The total number of cores identified is 3 This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. A doctor may prescribe surgery or perform an endoscopic procedure. Include Your Primary Care Physician as Member of Your Treatment Team. If anyone has used him, please let me know what your experience was like. I'll post the whole thing, my doc and my own comments, and then cut/paste all my MRI results in case anyone REALLY liked data. However, learning more about prostate cancer and prostate-related health issues can help optimize health. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. He recommended waiting and watching at that time due to the lower PSA reading. One Johns Hopkins study showed that out of 14,000 men who had surgery and were found to have Gleason 6 cancer confined to the prostate, "zero of those 14,000 men had lymph node metastases. As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. Dr. Nour - Emory in Atlanta. I have searched the country for intervential radiologist that perform FLA on the prostate. Prostate, right medial base: Other labs for second . However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. Instructions for Second Opinion on Pathology (Gleason score) 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) He schedules appointments with a Radiologist and two local surgeons. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. * Perineural Invasion also detected It also rules out Brachytherapy. I have posted here before, now with an update. 5. So off I went to see a community urologist who performed a needle biopsy in his office. 3. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. How long do you have left? Following the advice of all on here, I need a team of doctors to manage my care. Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. ADC: mean 879 / median 839 / st dev 223 My urologist suggested a couple more PSA tests followed by an MRI. I just turned 71 in February. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. Of course that was before I found this webpage and I really didn't know what 1 core of 18 samples showing 3+4=7 Gleason meant. Jonathan Epstein, MD received his doctorate from Boston University. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Second opinions apply to biopsies and imaging as well. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. I trust the second opinion Dr. Bush gave. restricted diffusion. This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. 4/16 3T MRI performed (reports/re-reads below) I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. I luckily found this webpage and I started reading everything I could get my hands on. - Benign prostatic tissue So fingers crossed. Now, I would like to send Radiology for a similar review. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. This teamwork ensures the best possible patient outcomes. There is no bony or bulky nodal disease in the pelvis IMPRESSION: And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. Depending on your location, you may be able to have a telemedicine consultation. The results seemed fairly benign and my urologist and I decided to continue to monitor with 2 more PSA tests and then consider an MRI in April 2021. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. I am also doing a vegan diet with additional complementary substances. Prostate, left lateral base: - Johns Hopkins Medicine -- Get a Second Opinion After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. Second Opinions for Cancer Care - UChicago Medicine I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. Prostate Cancer Grading: They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. I appreciate any comments or insight that anyone wants to share. This condition causes pain in the lower back and groin area, and may cause urinary retention. Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com I'm leaning towards SBRT. * Adjacent organ invasion: None. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. MRI obtained outsideon 04/16/2021. radiation, active surveillance, surgery, hormone therapy, and more. MM, Much to my dismay my 4th targeted biopsy Oct 12 revealed 5% G4 (upgraded from Grade Group 1 to 2 (Gleason 3+4 intermediate/favorable). Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. Every year I got a PSA and DRE during my annual physical. There is hope. That's the good news. Other: There is trace ascites in the mesosigmoid. Primary Gleason grade: 3 Grade Group: 1 I would love to hear from anyone who has been involved in the Chicago study. H. Prostate, lesion #2, core biopsy: In the rare chance a baby needs highly specialized care, the team at Johns Hopkins is available to treat rare and complex conditions through breakthrough fetal procedures. All rights reserved. It is OK to be overwhelmed with info. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. Two from one lesion were positive as was one of the two from the other. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. The primary goal is to be cured with the least toxic, most effective approach. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: But in the spirit of disclosure for those of you with BPH a TURP can complicate a future Radical Prostatectomy (or possibly Cryo) and increase the risk of side effect risks. One core had 5%, one 20%, and one 40%. * Perineural Invasion detected There are also some cases of the test showing no depletion but being wrong. His second opinion just came back. official website and that any information you provide is encrypted Conclusions: My strong preference would be to do FLA again and monitor. There are also many reasons why you may want to seek another opinion during the course of your cancer care. And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. Hello. Be sure to confirm your diagnosis at a center of excellence. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Hi All, And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Results: (TZ) One suspicious area - lesion size: 2cm x 1.4 cm present in bladder. If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S. Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. Diffusely decreased and I have already proven to myself that my body is good at cell mutation, so I wanted to be careful.At the 3 year mark (6 months after last MRI), my PSA spiked to > 6. Here are seven tips for seeking second opinions for prostate cancer: Before getting a second opinion, its important to know your stage of prostate cancer. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. Overall my PSA is between 4 and 10. EVERY DAY, they'd take a low dose X-RAY and low dose CT to align the fiducials and ensure my bladder was full and the bowel was empty. I luckily found this webpage and I started reading everything I could get my hands on. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans.
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