The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. A new study by researchers at the Johns Hopkins University has found that . 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. Immediate means 6 weeks just to see his NP. Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC Most choose treatment they originally planned to follow, study finds. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm It's really that simple! However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. Second opinion Biopsy came after FLA G-9. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. 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. My plan is to choose quality of treatment over cost of the treatment. 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. 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. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. We can help with your case. I luckily found this webpage and I started reading everything I could get my hands on. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. I still have some urgency and frequency issues, but I am not complaining too bad. It would be more convenient to use Mayo but I want the best practitioner regardless. This condition causes pain in the lower back and groin area, and may cause urinary retention. Hello everyone. Nov 7, 2016. Instead, I did my homework. Youve just been diagnosed with prostate cancer. There is no evidence Prostate, right anterior MRI lesion: Thanks, BigD. I had a very bad experience with an incompetent nurse that did a catheter change. 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. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. 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. They won't be offended, and they may even be able to recommend a specialist for you to see. 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. Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. According to The National Institute on Aging, prostate problems are common after age 50. Thanks, Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. Of course that was before I found this webpage and I really didn't know what 1 core of 18 samples showing 3+4=7 Gleason meant. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. The peripheral zone has a patchy signal pattern. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. A. Prostate, right base, core biopsy: Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. The treatment of prostate cancer has evolved tremendously. Primary Gleason grade: 3 Following the advice of all on here, I need a team of doctors to manage my care. I trust the second opinion Dr. Bush gave. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. My urologist suggested a couple more PSA tests followed by an MRI. doi: 10.1002/cncr.30412. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. 3. Getting a second opinion from us is easy, convenient, and all done remotely. Further, the two tumors in question have not really changed much in size for more than 2 years. Masks are required inside all of our care facilities. 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. Thanks for considering. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. I am relatively new to this forum and trying to educate myself as to my best course of treatment. And just this week, 1 YEAR post treatment, it is .46. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Send a Consult for Second Opinion | Johns Hopkins Pathology It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Even if I go the radiation route, should I try for Proton radiation or some other type? Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. His second opinion just came back. official website and that any information you provide is encrypted Breast Cancer: When to Get a Second Opinion - WebMD The urologist offered surgery and radiation as options on 3/10 when we met. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Benign Processes: If I am rested, I find that I am more ready than if I am not. 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.). Benign prostatic tissue Cancer patients are encouraged to obtain second opinions before starting treatment. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! 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. -------------------------------------------------------- I recently sent my Pathology Slides to Dr. Epstein for a Second Review. - High grade prostatic intraepithelial neoplasia (HGPIN) 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion 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. I was referred to a urologist and tested again in April at 4.40. 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. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. MRI obtained outsideon 04/16/2021. Same with the amount of how much pattern 4. Therefore, the value of these second opinions remains unknown. 8600 Rockville Pike It is OK to be overwhelmed with info. Here are seven tips for seeking second opinions for prostate cancer: 1. 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. * Location: Right, anterior, apex, peripheral zone Conflicting Prostate Biopsy OpinionsWhat to Do? 7 Tips for Seeking Second Opinions For Men with Prostate Cancer Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. Please enable it to take advantage of the complete set of features! 7. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. 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. If these do not work, your symptoms could progress and become chronic. 1: Prostate, right lateral apex Have been told a health condition is not treatable. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Be sure to confirm your diagnosis at a center of excellence. However, there were no other suspicious areas on MRI. It works. 1. Benign Processes: J Am Board Fam Med. Compared to younger men, men 70-74 years old and men 75 years were less likely to obtain a second opinion whereas men with college graduate level education or beyond were more likely compared to men with less than high school level education. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. 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. C. Prostate, right apex, core biopsy: An accurate diagnosis is essential to ensure the most effective treatment. Prostate cancer is an When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. 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. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) It is OK to be scared. You 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. The prostates function is to create some of the fluid that insulates sperm cells found in semen. Prostate Cancer | Johns Hopkins Brady Urological Institute They basically said it didn't matter. 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. 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." * PIRADS v2 Score: 3 Know Your Stage. Consult Fees In some cases, additional testing may be required. Overall PIRADS Score: 5/5 * Location: Left, anterior, base to apex, transition zone Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. Pathology Second Opinion-J.Epstein,M.D. Pathologist-Johns Hopkins Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. 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. And should I treat prostatitis before FLA? TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. Over kill and redundancy I know, but it's my money, my prerogative. I am already positively surprised that I am still alive 4.5 years after my diagnosis. My experience at Johns Hopkins was awesome. 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. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". In the United States, prostate cancer is among the most common cancers found in men. No extraprostatic extension. Get a Second Opinion An acute bacterial infection can cause a burning sensation. Lesions are all small or very small. - 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 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). Johns Hopkins is home to many of the world's leaders in Pathology. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. This championship swimmer sought a second opinion at Johns Hopkins. Second opinions offer different things in different circumstances, Dr. Matasar says. Maybe lycopene and pomegranate have helped. Prostate cancer is a slow growing condition. First 6 week PSA is undetectable. He is the past president of the International Society of Urological Pathology. The side effects of the cut, radiate, hormone regime are unacceptable to me. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. We will give that a shot and see how it turns out. 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. 4. Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? 1. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. And if so, what does being accepted in a AS program look like, do I need to be present at their location? I am doing one in 6 weeks, regardless. Greatest dimension 0.7cm . - DWI-ADC = 4/5 4: Prostate, right medial base My strong preference would be to do FLA again and monitor. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Because I had an implant in my ear, they would only give me a 1.5T MRI. In some situations, insurers will even insist on a second opinion. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive restricted diffusion. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. I didn't study for the test and it's possible some morning activities might have affected my test score :) A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. It was easy. Ask us questions on this webpage. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. However, learning more about prostate cancer and prostate-related health issues can help optimize health. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. 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. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. 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. The biopsy took 12 cores, two from each lesion area and 8 randomly. 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. 7. Recovery from Prostate Cancer | Bills Story. 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! I wish the VA would be more informative about this disease they owe it to our veterans. Prostate, right medial base: If pain is present, a digital rectal examination will reveal hard areas. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. You're also at greater risk of prostate cancer forming before age 50. IMPRESSION: Careers. 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%). Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. 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. 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. Benign fibromuscular stroma; no prostatic glands are identified (Recommended by my oncologist, Dr. Mark Scholz.) I worked out every day and it wasn't until the last week did I feel a bit fatiguedand experience a bit of urgency and hesitation having to peeflowmax fixed that right up!90 days after treatment my PSA came in at .56. Both Drs and nurses knew what they were doing and had lots of experience. Treatment options include immunotherapy, What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. E. Prostate, left mid, core biopsy: Second opinions from urologists for prostate cancer: Who gets - PubMed Netto says patients should be proactive in requesting that doctors take another look. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. Cancer 2017;123:1027-34. There is no one-size-fits-all treatment for prostate cancer. My diagnosis is T2c, Gleason 7 (3+4). We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Abstract Context: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. 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. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. 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. information. Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com Contact us or find a patient care location. Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers. Prostate, left anterior MRI lesion: Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. By basing a treatment How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. How could this compare using only partial slide re-reading? Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. My prior Prolaris study (2018) before the FLA was very low risk. Original Sloan Biopsy Results: This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night.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. - 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)
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