Intensity: min 148 / Max 459 Note respondents were able to, MeSH 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. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length Negative cancer in lymph nodes, seminal vesicles, and all margins. Sometimes, you may find out about treatment options you didnt know were available. Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. When to move from Active Surveillance to Treatment for Prostate Cancer? Read books and realize as soon as they are published, they are outdated. - T2 = 3/5 In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. In severe cases, a catheter may be required to relieve the symptoms. But I refuse to sit still, I continue to research and to plan, as best I can. peripheral zone signal intensity on T2-weighted images. Further, the two tumors in question have not really changed much in size for more than 2 years. A new study by researchers at the Johns Hopkins University has found that . However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. This may include imaging, blood tests, prior treatment, and pathology reports. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. You receive a secure, private online consultation without leaving home. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Overall my PSA is between 4 and 10. In fact, additional biopsies revealed no additional cancer. 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%). But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). Right mid anterior transition zone (PIRADS 2). I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. My prior Prolaris study (2018) before the FLA was very low risk. 1. Allow yourself the time to seek multiple opinions. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Epub 2017 Jun 12. Seek Perspective from a Range of Specialists. Prostate, left lateral apex: * Location: Left, anterior, base to apex, transition zone Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. !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. The biopsy took 3 samples from the targeted region plus 16 sextant. My PSA over time has been creeping up over time (1.8 - 5/16, 1.0 8/17, 2.68 8/18, 2.9 12/18, 3.28 2/19, 3.01 8/19, 3.65 2/20, 3.31 6/20, 3.88 12/20) but I was frankly a bit shocked when I received word that I have cancer. Overall PIRADS Score: 5/5 Find more COVID-19 testing locations on Maryland.gov. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. - High grade prostatic intraepithelial neoplasia (HGPIN) I personally have benefitted from second opinions on my so-called cancer journey. I would love to hear from anyone who has been involved in the Chicago study. 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. Request an Appointment 410-955-6100 In addition to cancer, our urologic team provides second opinions regarding urinary stone disease, urinary tract reconstruction, incontinence, male infertility and sexual health, and many other urologic conditions or procedures. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. PSA that brought me to this was 7.1. BJU Int. Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. Generally, the symptoms can stabilize over time. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. You May Like: Sbrt Radiation Therapy Prostate Cancer. Many thanks for that. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. My other option for treatment is either LDR or HDR brachytherapy. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. I luckily found this webpage and I started reading everything I could get my hands on. 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. 4. )As for side effectsI occasionally have some urgency/hesitancy having to pee. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. This teamwork ensures the best possible patient outcomes. 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. 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. Also Check: Prostate Cancer Stage 7 Treatment. 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. - 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 Also, infection was noted, so the current PSA is high in part due to prostatitis. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. 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. A second opinion can accomplish a number of things. FLA DONE AT FIRST BIOPSY G- 7. Is it done through my doctor or do I do it myself with sending CDs of the MRI? Types of questions that pathologists often address in our second opinions: Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. If anyone has used him, please let me know what your experience was like. Netto says patients should be proactive in requesting that doctors take another look. Anyway, would appreciate knowing how to contact Johns Hopkins. -------------------------------------------------------- If the enlarged prostate is not completely removed, it will shrink. This condition causes pain in the lower back and groin area, and may cause urinary retention. It's really that simple! Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine You're more likely to develop prostate cancers that are more likely to spread. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. Four had 60-70%, five have between 5-10%. And should I treat prostatitis before FLA? Anything I am overlooking or need to add to my list of considerations? 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. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. This is a PI-RADS 5 lesion in Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. 5: Prostate, left medial apex However, there are also many more options for treatment and these options are more complicated than in the past. I talked with Dr. Epstein who expressed Johns Hopkins' conservative views to not underestimate GS 6 and to consider surgery and/or radiation that have been used successfully for many years in saving lives. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. Grade Group: 2 However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. I appreciate any comments or insight that anyone wants to share. Grade Group: 1 We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. I now have my list whittled down to 3. Epub 2010 Oct 20. have no symptoms, and yet you have cancer? It hasn't let me down. 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! Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. 4. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. What are you doing about it? Many researchers believe PTEN present is a strong brake on I hope my story helps anyone out there just starting the process. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. It also rules out Brachytherapy. Our singular focus on treating cancer, and only cancer, means we have the expertise to confirm a diagnosis or treatment plan and offer options that may not have been considered. The linear amount of tissue with carcinoma is 11 mm With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. 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%). Prostate, right anterior MRI lesion: Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. Treatment must be chosen based on stage and your I guess TWO national centers of excellence are better than one? I have had a CT of the pelvic area - negative and a whole body bone scan - negative. Some specialists have more expertise and more experience than others. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. "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 . I'm leaning towards SBRT. 3. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. Question anemia. Dont Miss: Bladder Control After Prostate Surgery. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. * Adjacent organ invasion: None. Lesion 2: Right mid anterior transition zone. He is the past president of the International Society of Urological Pathology. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. I was referred to a urologist and tested again in April at 4.40. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). No definitive evidence of distant metastatic disease is seen." 10. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. 1. 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. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Some men may have an enlarged prostate but not notice it. Depending on your location, you may be able to have a telemedicine consultation. Following the advice of all on here, I need a team of doctors to manage my care. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it). So fingers crossed. Also, their protocol would be another biopsy, but he was comfortable with the image and velocity of PSA that he didn't have to have one to start treatmentand I was pretty hesitant (given the image and PSA) to take ADT, and didn't see a biopsy changing my mind regarding treatment and/or ADT.Oh. Biopsy Results: What Do They Mean? - Prostate Cancer Foundation Over 80,000 specimen cases are seen at Johns Hopkins each year. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. So now things are getting exciting. 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. 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. 2. You can call and speak with his assistant at: (410) 614-6330. The treatment of prostate cancer has evolved tremendously. The average age at the time of prostate cancer diagnosis is about 66. How could this compare using only partial slide re-reading? One to a 3+4=7 and the other to a 3+3=6. 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.). 2. The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. notable articles of 2016 - Johns Hopkins Bloomberg School of Second Opinion Pathology | MD Anderson Cancer Center While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. He also said I would tolerate any option well based on my age and health. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. About this time, I started reading this forum and my ignorance starts going away. In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. - Perineural invasion is present 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. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Diffuse probable benign peripheral zone changes limit evaluation for Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. Have been told a health condition is not treatable. 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. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results. It was easy. Hope to hear from a bunch of people. The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. Anyone else encounter something like this? Thanks, BigD. !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. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. If pain is present, a digital rectal examination will reveal hard areas. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. Conflicting Prostate Biopsy OpinionsWhat to Do? MRI obtained outsideon 04/16/2021. 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. Benign prostatic tissue ZERO - The End of Prostate Cancer Support Community. Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. 1. 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. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): It hasn't let me down. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Keywords: I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. 1. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). More medical freakouts. 3. Masks are required inside all of our care facilities. National Library of Medicine ORIGINAL MRI REPORT (local radiology group): -------------------------------------------------------- I wanted to keep my options open. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. Bookshelf Know Your Stage. B. Prostate, right mid, core biopsy: Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. So, Radiation Oncologist prescribed Cialis 5mg, daily. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? I am 65 and in excellent general health. IMPRESSION: I have selected Focal Laser Ablation as my future (soon) treatment. 3. PREVIOUS MRI RESULTS (LOTS of them) 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.

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