According to The National Institute on Aging, prostate problems are common after age 50. Reinterpretation of imaging scans and lab tests. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. So now things are getting exciting. Consultation with your nurse care manager. Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists. The more accurate the information we have, the better our treatment decisions. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. We specialize in minimally invasive procedures to treat BPH, including: For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success. There are lots of lessons learned on the forum. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. 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. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? They are not objective. So, I also sent this MRI result to Johns Hopkins for a second opinion. It is very rare (<3% of all prostrate cancers) and potentially very lethal (one study showed that 59% of men in the study with Gleason scores of 5 had died within 3 years and it had metastasized in 13% of the remaining men). If the enlarged prostate is not completely removed, it will shrink. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. Lesion 1: Left mid-base transition zone. It is OK to be overwhelmed with info. Get a Second Opinion 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. Hoping that after I go through this that my advice to others will be able to guide them and that they can learn from my experience, as I feel I am gaining a solid foundation from both a practical and mental standpoint. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! The peripheral zone has a patchy signal pattern. Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. That's the good news. Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. Pathology Second Opinion-J.Epstein,M.D. Pathologist-Johns Hopkins The site is secure. My strong preference would be to do FLA again and monitor. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. In some situations, insurers will even insist on a second opinion. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. But I did speak to an oncologist who wanted to order Oncotype, which I did. 180 days after treatment PSA was .50. J Am Board Fam Med. Everything seems to be on track to remove the cancer and be cured! MRI RE-READ #3 (National Cancer Center of Excellence): Before Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Prostate, right medial apex: His second opinion just came back. Thanks to all of you for sharing! - Benign prostatic tissue Men with a college education or beyond also were more likely to cite wanting more information about their cancer as a motivation for a second opinion . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). -------------------------------------------------------- Wondering if any of the "gurus" here want to take a stab at looking at this and see if they agree that it says what I think it says (I will be following up with doctor(s) to get their opinion, and I waive all HIPAA rights by allowing this to be seen). For these reasons, it is a good idea for HMO members to get a second opinion and make sure they are informed about clinical trials or other promising new treatments. JHs just said it was minimal less than 5%. 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. MEASUREMENTS: Benign Processes: 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. My other option for treatment is either LDR or HDR brachytherapy. DRE is always normal. Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. DIAGNOSIS: This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. It is still important to do your own research. Fear motivates you to want to treat this as soon as possible. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. How long do you have left? Brachytherapy Experience with Dr. Albert Chang at UCLA? 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. Other labs for second . I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. Video consultation and written report from your expert. !I've pasted a previous update below for background.I just got my PSA results and the numbers are still trending in the right direction. Anyone with insight into this and advice? 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Had my PSA remained static I'd have remained on AS and had I grown a Target Lesion I'd have sought focal treatment.This science is emerging and only getting better. I retested in January 2019 and scored 4.20. He also said perinueral invasion, but not extracapsular extension. LESION 2 I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. -------------------------------------------------------- Day 7 after surgery I took my last pain pill. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. He basically said it was possible, but that he did not agree. There are also many reasons why you may want to seek another opinion during the course of your cancer care. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. Hi All, radiation, active surveillance, surgery, hormone therapy, and more. Find more COVID-19 testing locations on Maryland.gov. Patients may experience a fever or chills as a result of the infection. Where to start for newly diagnosed advance prostate cancer Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. You can call and speak with his assistant at: (410) 614-6330. I've tried to find out about Dr. Wong but there's very little info on him. Urology. IMPRESSION: No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." Hello everyone. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Have been diagnosed with a serious or rare health condition. My plan is to choose quality of treatment over cost of the treatment. My urologist suggested a couple more PSA tests followed by an MRI. Sometimes, you may find out about treatment options you didnt know were available. Seems like a simple request. However, something is driving my PSA. 1. What are your opinions of what that is, and where to get it? 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. Epub 2017 Jun 12. I wanted to keep my options open. So, Radiation Oncologist prescribed Cialis 5mg, daily. 3. Thanks! In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could have a significant impact on treatment and prognosis. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. F. Prostate, left apex, core biopsy: The symptoms of acute bacterial prostatitis are similar to those of CPPS. You have a rare or unusual cancer. A second opinion can accomplish a number of things. My family physician for years told me that small increases PSA was common so when it went over 4 it didnt bother me and my Dr who was retiring, didnt say anything either. Where Should I Go for a Second Opinion? - breast cancer 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. 2. 5: Prostate, left medial apex ADC: mean 879 / median 839 / st dev 223 Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". * PIRADS v2 Score: 5 They replied they are sending the slides but they said they're looking into the DX test and will get back to me once they have that information. Johns Hopkins Health - Second Opinions, Second Chances, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, High Blood Pressure May Take Its Toll on Your Kidneys. I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) I'm leaning towards SBRT. -------------------------------------------------------- Also, in 2018 I had an exosome Dx test which scored 45.34, but I also retook that test this year and it went down to 30.79. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. Obviously the Covid 19 issue is playing a part in all of our decisions. If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. 2020 Dec 1;3(12):e2028320. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. But I refuse to sit still, I continue to research and to plan, as best I can. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Metastatic disease considered less likely for this pattern. In 2006 my PSA was .6. Many thanks for that. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. If these do not work, your symptoms could progress and become chronic. Instructions for Second Opinion on Pathology (Gleason score) He said that it will improve in the future due to future improvements in the treatments. A newly published paper by Fischer et al. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. Cancer patients are encouraged to obtain second opinions before starting treatment. Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. In severe cases, a catheter may be required to relieve the symptoms. How could this compare using only partial slide re-reading? PSA had increased to 5.4. We had the 3T MRI (no coil) and MRI guided biopsy at Sperling in NY, and then had a 2nd Opinion done by Johns Hopkins. Not all cancers are the same and not all treatment plans are absolutely clear. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. - Perineural invasion is present Im immediately referred to Urologist. It can be caused by many factors, including infection and inflammation. The linear amount of tissue with carcinoma is 11 mm HHS Vulnerability Disclosure, Help I recently sent my Pathology Slides to Dr. Epstein for a Second Review. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. * Other 12 slides not sent Also, a second opinion provides the opportunity to get information from someone other than the physician who will be directing treatment, which is usually the main source of information for most patients. Breast Cancer: When to Get a Second Opinion - WebMD undefined will no longer be visible to you including posts, replies, and photos. If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. I tried to send the samples out for genetic testing to Prolaris and Decipher, but there was an ordering error and they never went thru. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This teamwork ensures the best possible patient outcomes. Left mid-base transition zone (PIRADS 5). Here are seven tips for seeking second opinions for prostate cancer: 1. They basically said it didn't matter. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. You may choose to consider a second opinion if you: A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. 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. I suggest for all that hear, "you have cancer" that you seek more opinions! - DWI-ADC = 4/5 * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find. I say bullshit to them. 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? Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. Prostate cancer is an If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. Noted that some don't even include on report and should be looked as something to note but not obsess about. A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. Even at the age of 48, he thought I would be a good candidate for AS. Two 1cc tumors, gleason score 3+4 each, one in each lobe. We specialize in minimally invasive treatments for prostate cancer such as: We place a high priority on sparing the nerves and tissue around the prostate whenever possible. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. 4. - 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) Dont Miss: Bladder Control After Prostate Surgery. However, a new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice or the persons perception of the quality of care they receive, at least among low-risk men. International Patients: How to Request a Remote Second Opinion When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. Second opinion on biopsy slides - malecare.org Prostate, right medial base: present in bladder. Dont Miss: Screening For Prostate Cancer Icd 10. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues. Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. 3. 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. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. Following his residency in anatomic pathology at The Johns Hopkins Hospital in Baltimore, Maryland, and a fellowship in oncologic pathology at Memorial Sloan Kettering Cancer Center in New York., he then joined the staff at The Johns Hopkins Hospital and has been there his entire career. Race and ethnicity. 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. What are you doing about it? have no symptoms, and yet you have cancer? Based on the results, our experts can provide you with an individualized treatment plan before you leave. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. Conclusions: Now, I would like to send Radiology for a similar review. Question anemia. Finally, things are set and I know what is going to happen. I hope my story helps anyone out there just starting the process. Would you like email updates of new search results? There is no extraprostatic extension. 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. Reasons for getting a second opinion include: You want to be sure you have explored all options. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. Either the patient or the primary physician can initiate the process of getting a second opinion. Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. and transmitted securely. I met with the radiologist 3/17 and he leans toward an IMRT radiation regimen of 5 or 20 sessions TBD combined with ADT (6-month shot but maybe 4 months was enough). Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. MRI RE-READ #2 (VERY VERY well respected radiologist): After applying exclusion criteria, the final analytic cohort included 2365 respondents. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. curing cancer, prostate cancer questions johns hopkins hospital, josef issels wikipedia, cancer a second opinion a look at book by josef issels, coping with metastatic cancer cancer net, pdf americans health priorities curing cancer and, what is immunotherapy cancer research institute cri, cancer a second opinion a . The biopsy took 12 cores, two from each lesion area and 8 randomly. I would really love to hear from you. It took me awhile but minutes ago received my second opinion from Johns Hopkins. Here are the details: You receive a secure, private online consultation without leaving home. An increase of 1.1 in 3 months is not good news. You're at greater risk if you're Black or of African ancestry. Prostate, right anterior MRI lesion: Most choose treatment they originally planned to follow, study finds. Thanks, BigD. Generally, the symptoms can stabilize over time. Clipboard, Search History, and several other advanced features are temporarily unavailable. There are so many different departments at Hopkins that I don't know the optimal department to contact.
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