Especially opinions other than those of the first Urologist you see. Even if I go the radiation route, should I try for Proton radiation or some other type? My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. images and markedly reduced ADC. * PIRADS v2 Score: 3 1: Prostate, right lateral apex 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. You The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Discover what's to love about Charm City for yourself. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. To learn more about how to get a Neuropathology second opinion, please visit our Neuropathology Division second opinions website. Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. of tumor in the rectal prostatic angles. 2. Hello, I apologize upfront for the length of this post, but I was recently diagnosed with prostate cancer (T2C) and figure more information is better than not enough. 10. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. 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. Conflicting Prostate Biopsy OpinionsWhat to Do? It got discussions started and questions answered. Now, I would like to send Radiology for a similar review. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. Obviously the Covid 19 issue is playing a part in all of our decisions. Greatest dimension 2cm. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. Benign prostatic tissue 3/3 4K score 19% (high end of intermediate) Unauthorized use of these marks is strictly prohibited. IMPRESSION: Overall PIRADS Score: 5/5 When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. It works. Dr. Dan Sperling - New York. A new study by researchers at the Johns Hopkins University has found that . -------------------------------------------------------- Hope to hear from a bunch of people. He said that it will improve in the future due to future improvements in the treatments. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. Johns Hopkins is home to many of the world's leaders in Pathology. How important is Oncotype DX test for Gleason 7? We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Consult Fees In some cases, additional testing may be required. 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. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. Request an Appointment 410-955-6100 Thanks, 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 . 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. That being said, they can be a beneficial member of the treatment team. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. 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. 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. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. There is no extraprostatic extension. 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. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. 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. Benign prostatic tissue Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. 4. My mind goes all over the place as to why this is. It starts many years ago. !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. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. John. Patients may experience a fever or chills as a result of the infection. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. 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. Enter the last name, specialty or keyword for your search below. * Seminal vesicle invasion: None. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. She put me in the hospital. 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. IMPRESSION: I didn't study for the test and it's possible some morning activities might have affected my test score :) 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. I now have my list whittled down to 3. I'm Gleason 3+4=7, and I believed only 2 cores tested positive. The review process normally takes several days, after which we will send your slides and other materials are returned. At this point, I am convinced I made the right treatment choiceOHFOR THOSE THAT DON'T KNOW, THE VA HAS MADE REPRODUCTIVE CANCERS A PRESUMPTIVE CONDITION FOR THOSE THAT SERVED IN MOST OF THE WAR ON TERROR LOCATIONS.Good luck fellas and my prayers are with all of you having to contend with this disease. You think your doctor is underestimating how serious your cancer is. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. If they have an enlarged colon, their physician can perform a TURP procedure. 3. After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. Prostate, right medial base: I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. Check Biopsy and Imaging Results for Accuracy. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. I followed up with the original pathologist to compare and he was more forthcoming. 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 . He also said I would tolerate any option well based on my age and health. Following the advice of all on here, I need a team of doctors to manage my care. Getting a second opinion from us is easy, convenient, and all done remotely. doi: 10.1002/cncr.30412. 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. This is often the case when the primary physician advises an expensive treatment. Do any of you have an opinion or actual experience with any of the three listed below? My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. 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. The people were great. We are vaccinating all eligible patients. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. 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. If pain is present, a digital rectal examination will reveal hard areas. Have been told a health condition is not treatable. Over 80,000 specimen cases are seen at Johns Hopkins each year. 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. I was referred to a urologist and tested again in April at 4.40. Men need to be educated on all treatment options to protect themselves from a biased industry. More medical freakouts. Brachytherapy Experience with Dr. Albert Chang at UCLA? Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. We are vaccinating all eligible patients. And again, most of you tell me time is on my side, so I am comforted in hearing that. What are you doing about it? 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. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. Find more COVID-19 testing locations on Maryland.gov. The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. World J Urol. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) It is OK to not understand all the terminology. Seminal vesicles and other margins are negative for tumor. Oncologist. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. 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. Younger men also sought the 'best' doctor. 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. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. This has raised some questions on all the scans so far. Prostate, left lateral apex: Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. So my question for you is have you ever heard of PRECISE and if so what should I make of it? Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. doi: 10.1136/bmjopen-2020-044033. * Other 12 slides not sent When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. Seek Perspective from a Range of Specialists. Surabhi Dangi-Garimella, PhD. Two weeks later I meet with my Johns Hopkins Dr. Noted that some don't even include on report and should be looked as something to note but not obsess about. __________________________________________________________________________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. 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. I just received a second opinion report from Johns Hopkins. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Other labs for second . Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Im immediately referred to Urologist. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. I was diagnosed with a 3T MP MRI and a 3T MP MRI guided 4 core biopsy. More medical freakouts. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. B. Prostate, right mid, core biopsy: 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. I have searched the country for intervential radiologist that perform FLA on the prostate. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Two from one lesion were positive as was one of the two from the other. I retested in January 2019 and scored 4.20. focal peripheral zone lesions. I have selected Focal Laser Ablation as my future (soon) treatment. 5. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive 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. In the mean time my PSA was movingno longer static, but never back up to 6. 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. 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. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. Fear, confusion and uncertainty set in. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. PROSTATE LESIONS: At that point I agreed to the TRUS biopsy which I had on October 10, 2020. * Perineural Invasion detected I did ask some questions about the study, if anyone is interested. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. 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%). A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. This shows very high signal intensity on the diffusion-weighted A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. Then about a month later I started 28 fractions of Proton Radiation.It was painless. This is why the prostate is important to the body. Hi All, 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. We are vaccinating all eligible patients. You're at greater risk if you're Black or of African ancestry. Four had 60-70%, five have between 5-10%. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. If these do not work, your symptoms could progress and become chronic. Because every patient is different, there are several ways to approach prostate cancer treatment. 3. - DCE = (+) Nov 7, 2016. 5. The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. Anyone else encounter something like this? After a little experimenting I have been able to achieve a partial erection. Lesions are all small or very small. 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. JHs just said it was minimal less than 5%. MEASUREMENTS: sharing sensitive information, make sure youre on a federal 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. Anyway, would appreciate knowing how to contact Johns Hopkins. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. PELVIC LYMPH NODES: No adenopathy. 3. Be sure to confirm your diagnosis at a center of excellence. 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. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Prostate cancer is the second-most diagnosed cancer in American men. Jonathan Epstein, M.D. My first PSA was 8.03. 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. 4. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. MRI obtained outsideon 04/16/2021. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Prior to the results, the oncologist said that the literature shows that a 3+4=7 with less than 5% pattern 4 behaves just like a 3+3=6 and basically is an indolent tumor. At this time, I am leaning towards Active Surveillance or FLA. AS would be my choice, except that a total of three lesions, on both sides of Peripheral Zone, makes this controversial. Dont Miss: Can Prostate Problems Cause Burning Urination, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Johns Hopkins Prostate Cancer Second Opinion, treat rare and complex conditions through breakthrough fetal procedures, Function Of The Prostate Gland And Seminal Vesicles, Best Treatment For Intermediate Prostate Cancer, How Old Can You Be To Get Prostate Cancer, New Treatments For Stage 4 Prostate Cancer, Prostate Radiation Treatment Side Effects, Can Prostate Problems Cause Burning Urination, Prostate Cancer Spread To Skull Prognosis, Life Expectancy Stage 4 Prostate Cancer No Treatment, Diagnostic Procedures For Prostate Cancer. Johns Hopkins second opinion - nothing found. - High grade prostatic intraepithelial neoplasia (HGPIN) He was right. 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. - Perineural invasion is present Extracapsular extension: The prostatic capsule is preserved. He also stated that he would ONLY recommend FLA if done within a trial. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): My long-term prognosis appears to be good with minimal side effects. I recently sent my Pathology Slides to Dr. Epstein for a Second Review.
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