* Location: Right, anterior, apex, peripheral zone Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). In other words, the cancer is still contained within the prostate. I was referred to a urologist and tested again in April at 4.40. Johns Hopkins Prostate Cancer Second Opinion My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. This is not true. In general, a second opinion is a good option for people who have recently received a cancer diagnosis but have not started treatment, as well as for people who have already completed chemotherapy or radiation treatment. This condition causes pain in the lower back and groin area, and may cause urinary retention. It is OK to be scared. Prostate Cancer: Symptoms, Causes & Treatment - Cleveland Clinic A report with the diagnosis will be faxed to your doctor. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. Right mid anterior transition zone (PIRADS 2). These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? Interesting differences: An accurate diagnosis is essential to ensure the most effective treatment. Greatest dimension 0.7cm . For a second opinion on the results of your prostate biopsy, there is no place better to get one than from the well known prostate pathologist, Dr. Jonathan Epstein at Johns Hopkins. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Rectal cancer.A small trial that saw 18 rectal cancer patients taking the same drug, dostarlimab, appears to have produced an astonishing result: The cancer vanished in every single participant. Some of the more common treatments that you and your doctor may discuss include: Prostate cancer experts at the Brady Urological Institute have created tools that help patients and doctors across the world assess risk and make treatment decisions. radiation, active surveillance, surgery, hormone therapy, and more. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine Primary Gleason grade: 3 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. A few weeks later and just before my meeting with my new Johns Hopkins Dr I get the second opinion results from both biopsy and MRI. Ozzieville (Michael), Hello All and thanks for being here~This is my first post.My husband was diagnosed with PC (adenocarcinoma with Extensive Intraductal Carcinoma Present) a few weeks ago. The review process normally takes several days, after which we will send your slides and other materials are returned. By Dec 2019, my PSA reached 4.13. Many researchers believe PTEN present is a strong brake on 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. Where Should I Go for a Second Opinion? - breast cancer In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . The urologist offered surgery and radiation as options on 3/10 when we met. Unbelievable that this happened!!! I was confident I was making the right decision. Recently diagnosed a Gleason 3 + 3. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. I certainly would - after all, there's a certain brotherhood bond here. The people were great. Instructions for Second Opinion on Pathology (Gleason score) So fingers crossed. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. Caused me to bleed heavily. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. In fact, additional biopsies revealed no additional cancer. Thanks for considering. Second Opinions in Prostate Cancer - American Council on Science and Health Below is the link with instructions and the authorization form for you to use with your doctor. 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. You're also at greater risk of prostate cancer forming before age 50. Conflicting Prostate Biopsy OpinionsWhat to Do? Dr. Nour is 100% sure that nothing has spread. For cancers that are less common, second opinions can offer more treatment options. Prostate cancer is the second-most diagnosed cancer in American men. This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! 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. Cancer. If these do not work, your symptoms could progress and become chronic. By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. You can call and speak with his assistant at: (410) 614-6330. My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. 8600 Rockville Pike Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. Johns Hopkins is home to many of the world's leaders in Pathology. I was offered to have my first biopsy sent to Johns Hopkins for second opinion and said why not? which came back with Gleason 9 three weeks after having the what we thought was G-7 ablated. Either the patient or the primary physician can initiate the process of getting a second opinion. It hasn't let me down. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. From what I've learned from Dr. Scholz videos at PCRI, and from posts on this site it would lead me to believe the DX test is fairly common knowledge. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. Younger men also sought the 'best' doctor. ---------------------------------------------------- 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) Breast Cancer: When to Get a Second Opinion - WebMD 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. I followed up with the original pathologist to compare and he was more forthcoming. Second opinions apply to biopsies and imaging as well. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. 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. That's the good news. 6. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Recovery from Prostate Cancer | Bills Story. For cancers that are less common, second opinions can offer more treatment options. Secondary Gleason grade: 4 We have a consult on Friday with the 1st opinion doc to review all tests. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Pingback: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Pingback: Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Your email address will not be published. There is no evidence E. Prostate, left mid, core biopsy: 2. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . You're more likely to develop prostate cancers that are more likely to spread. We will then prepare a written recommendation regarding your treatment plans or options. 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. Bookshelf Dr. Erick Walser at University of Texas Medical Center. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion Diffusely decreased 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. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. Benign Processes: If I am rested, I find that I am more ready than if I am not. BASE DATA: It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. You think your doctor is underestimating how serious your cancer is. These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Precision Medicine Center of Excellence for Prostate Cancer, robotic-assisted radical laparoscopic prostatectomies, The Brady Urological Institute and the Johns Hopkins Kimmel Cancer Center take a, Our urologic surgeons have extensive experience performing, Our surgeons, oncologists and radiologists are also world leaders in prostate cancer research, giving patients access to the latest discoveries and. We can help with your case. They won't be offended, and they may even be able to recommend a specialist for you to see. However, there are also many more options for treatment and these options are more complicated than in the past. In some situations, insurers will even insist on a second opinion. My plan is to choose quality of treatment over cost of the treatment. Over kill and redundancy I know, but it's my money, my prerogative. Here are the details: Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? You May Like: Best Treatment For Intermediate Prostate Cancer. They agreed with the PI-RADS 4. 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. :) When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. 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. But I refuse to sit still, I continue to research and to plan, as best I can. 4. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. World J Urol. Move ahead to Dec 2020. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. Some specialists have more expertise and more experience than others. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. I appreciate any comments or insight that anyone wants to share. John. Director of Surgical Pathology- Johns Hopkins, http://pathology.jhu.edu/department/services/secondopinion.cfm, The guy I used along with everyone else is Jonathan Epstein, M.D. There is no bony or bulky nodal disease in the pelvis My experience at Johns Hopkins was awesome. This is often the case when the primary physician advises an expensive treatment. MRI RE-READ #2 (VERY VERY well respected radiologist): 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. I can do radiation as a monotherapy. Prostatic Adenocarcinoma Intensity: min 148 / Max 459 Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. Surgeon wants next PSA in 3 months. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). If these do not work, your symptoms could progress and become chronic. Confirm biopsy and imaging results with centers of excellence before making any final decisions. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. Receiving a second opinion was not associated with perceived quality of prostate cancer care. The biopsy took 3 samples from the targeted region plus 16 sextant. Best practices dictate that you obtain a second confirmatory pathology evaluation. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). A second opinion can help you make an informed, confident decision about your medical care. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. I say bullshit to them. I am 65 and in excellent general health. - 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) Find more COVID-19 testing locations on Maryland.gov. IMPRESSION: I trust the second opinion Dr. Bush gave. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Seek Perspective from a Range of Specialists. What are you doing about it? And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. 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. Given that some 3+4 is now evident, I can no longer say that all my PCa is all 3+3 and that I can stay on AS for an extended period. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. This condition causes pain in the lower back and groin area, and may cause urinary retention. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Johns Hopkins second opinion - nothing found. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. A doctor may prescribe surgery or perform an endoscopic procedure. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. 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. More medical freakouts. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. Race and ethnicity. 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. Two weeks later I meet with my Johns Hopkins Dr. PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri transition zone. 2. An acute bacterial infection can cause a burning sensation. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. 8: Prostate, left lateral base I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. Second opinion Biopsy came after FLA G-9. 6. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! We are vaccinating all eligible patients. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). Hi All, This may include imaging, blood tests, prior treatment, and pathology reports. G. Prostate, lesion #1, core biopsy: According to the doctor it is around 3 mm. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm The more often a doctor diagnoses and treats prostate cancer the more proficient they become. 1. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. The peripheral zone has a patchy signal pattern. Prurigo Nodularis Cancer: What's the Link? - Verywell Health It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. A. Prostate, right base, core biopsy: The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. 5: Prostate, left medial apex And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. In severe cases, a catheter may be required to relieve the symptoms. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. The biopsy took 12 cores, two from each lesion area and 8 randomly. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. Background: 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. Please don't hesitate to make any observations or ask questions. Thanks, BigD. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. I retested in January 2019 and scored 4.20. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. On the first scan (post FLA) a lesion was identified by the local radiologist that performed the scan, but the FLA radiologist that performed my procedure was over reading and monitoring my care and stated strongly that there was no cancer. I am 62 years old. It would be more convenient to use Mayo but I want the best practitioner regardless. * Adjacent organ invasion: None. Brief MRI history. An acute bacterial infection can cause a burning sensation. And if so, what does being accepted in a AS program look like, do I need to be present at their location? I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). restricted diffusion. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. MRI June 2017 again at SMIL. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. 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.). Generally, the symptoms can stabilize over time. In the United States, prostate cancer is among the most common cancers found in men. My prior Prolaris study (2018) before the FLA was very low risk. About this time, I started reading this forum and my ignorance starts going away. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. Nov 7, 2016. Consult Fees In some cases, additional testing may be required. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. I understand that patient privacy is a priority (I'm actually a privacy lawyer), but surely there are patients who would give consent and be happy to talk with a prospective patient about their experiences? "We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer," said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in . In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. - Benign prostatic tissue This is the most common urinary tract problem in men under 50, and the third most common in men over 65. 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. The people were great. The lesion also shows focal increased permeability. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. Good pathology readings require experience and a high level of expertise. 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.). * Seminal vesicle invasion: None. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. I wish the VA would be more informative about this disease they owe it to our veterans. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. I had a very bad experience with an incompetent nurse that did a catheter change. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850.
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