This may include imaging, blood tests, prior treatment, and pathology reports. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? It is OK to not understand all the terminology. We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. This teamwork ensures the best possible patient outcomes. Prostate, left medial base: 1. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. The peripheral zone has a patchy signal pattern. Read Also: What Are The Signs Of Prostate Infection. I had my first of those 2 PSA tests last week and it dropped to 4.77. Suspicion for malignancy left anterior base-to-apex transition zone; 2. 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. There is no extraprostatic extension. 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. The results were ambiguous. 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. 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. Total Gleason score: 6 Sometimes, you may find out about treatment options you didnt know were available. It has been 2.5 years and the PSA has still not doubled as well. 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. Find more COVID-19 testing locations on Maryland.gov. For these reasons, it is a good idea for HMO members to get a second opinion and make sure they are informed about clinical trials or other promising new treatments. Obviously the Covid 19 issue is playing a part in all of our decisions. 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. Medical record collection from doctors and hospitals. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. I have posted here before, now with an update. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. 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. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. Benign prostatic tissue First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Watch: Are supplements good for prostate health? Last checkup (July 2022) my PSA was .46 and it is currently at .32.I am still eating primarily a plant based diet (only lean meats/cheeses/eggs about 10% of my diet) and maintaining steady weight and I am still quite active physically.As for symptomswith 5mg Daily Cialis the occasional ED symptoms have pretty much gone away. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has 6. And it is OK to have paralysis by over-analysis. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. * Size: 1.5 cm It was easy. 4. Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. A week later had catheter removed and had no bladder leakage problems. 1st opinion. - Perineural invasion is present NONE of the many radiation oncologists, surgeons or urologists I've spoken with in my journey have ever mentioned the term to me so I had to look it up. In the mean time my PSA was movingno longer static, but never back up to 6. Many thanks for that. Patients may experience a fever or chills as a result of the infection. Either the patient or the primary physician can initiate the process of getting a second opinion. MRI RE-READ #3 (National Cancer Center of Excellence): 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. 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. Prostatic Adenocarcinoma You May Like: Best Treatment For Intermediate Prostate Cancer. present in bladder. The primary goal is to be cured with the least toxic, most effective approach. 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 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. My urologist suggested a couple more PSA tests followed by an MRI. After all, it seems like good idea to deal with your cancer sooner rather than later. Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. To schedule an in-person visit for a second opinion or to determine if a telemedicine consultation is possible, call: 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. 7: Prostate, left lateral apex He was right. 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. I was on disability from work the entire time (not that I was disabled, but as a pilot, I couldn't very well work and get treatment at the same time. 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.). Then about a month later I started 28 fractions of Proton Radiation.It was painless. My experience at Johns Hopkins was awesome. FLA DONE AT FIRST BIOPSY G- 7. * IF ANYONE reading this doesn't believe in the value of MRI first and targeted biopsy next then take note that my systematic biopsy cores showed 0 positive in 8 cores and my MRI guided core samples were 6 for 6 being positive! 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. Prostate, left lateral apex: Any input on this would really be appreciated. You may choose to consider a second opinion if you: A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. The biopsy took 12 cores, two from each lesion area and 8 randomly. Grade Group: 2 Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. U.S. News & World Report ranked the institute #7in the country. 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. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. Due to the spread of the Coronavirus worldwide and the first confirmed case of the Coronavirus disease in Turkey, the executive team of the Anadolu Medical Center has taken preventive measures to protect the patients and their relatives. Find more COVID-19 testing locations on Maryland.gov. * Location: Left, anterior, base to apex, transition zone The prostates function is to create some of the fluid that insulates sperm cells found in semen. I have been drinking out of an information fire hose. However, learning more about prostate cancer and prostate-related health issues can help optimize health. intricate disease and not all doctors have the same amount of experience 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. F. Prostate, left apex, core biopsy: To learn more about how to get a Neuropathology second opinion, please visit our Neuropathology Division second opinions website. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. When to move from Active Surveillance to Treatment for Prostate Cancer? 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. Interesting differences: Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. I tried to send the samples out for genetic testing to Prolaris and Decipher, but there was an ordering error and they never went thru. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. Jonathan Epstein, M.D. 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. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. I find that when I'm trapped in the cockpit not able to use the bathroom for a long time is when I experience that most. Medical record collection from doctors and hospitals. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. 1. Also, infection was noted, so the current PSA is high in part due to prostatitis. I really just want the results of their innovative PTEN test. I choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. I suggest for all that hear, "you have cancer" that you seek more opinions! 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. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. He is the past president of the International Society of Urological Pathology. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. 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 also many reasons why you may want to seek another opinion during the course of your cancer care. I didn't study for the test and it's possible some morning activities might have affected my test score :) Reinterpretation of imaging scans and lab tests. Potentially inaccurate results can lead to selection of the wrong type of therapy. We specialize in minimally invasive procedures to treat BPH, including: For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success. have no symptoms, and yet you have cancer? If these do not work, your symptoms could progress and become chronic. I had FLA done after first biopsy which staged me at 3+4 = 7. 180 days after treatment PSA was .50. I applaud Dr Scholz for his dedication and explanation of such a complex cancer, that has not had his common sense help available for men with prostate cancer. At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. 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. 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. Now, I would like to send Radiology for a similar review. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Ask your doctor for a copy of your complete medical record. Second opinions offer different things in different circumstances, Dr. Matasar says. 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. 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. Greatest dimension 2cm. Overall PIRADS Score: 5/5 Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Everything seems to be on track to remove the cancer and be cured! 5. I'd like to talk with former patients who have gone through the procedure. And thanks again for making this such a great support group! By basing a treatment 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). The problem is that all 3 pathologies noted an intraductal component. It hasn't let me down. I could not get a definitive answer from them on how much, how many cells, or any information. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. All wanted to do what they do, schedule treatment which at this time is only Gleason 6 which I now know is not life threating. After applying exclusion criteria, the final analytic cohort included 2365 respondents. 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. Consult Fees In some cases, additional testing may be required. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. I retired as a Dentist at the VA and saw many veterans with a wide range of outcomes as most of them became 100% service connected when diagnosed with prostate Ca due to exposure to Agent Orange if they served in Vietnam. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Y'all are in my prayers! P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. OTHER: None. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. 30%/40% or higher)? Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. PI-RADS v2 score: 5. Lesions are all small or very small. This is why the prostate is important to the body. asymmetric central zone tissue more pronounced on the left. 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. 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. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. The percentage of Gleason grade 4 and/or 5 is 5 % Greatest dimension 0.7cm . I'm Gleason 3+4=7, and I believed only 2 cores tested positive. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. I'm trying to figure out why the PSA keeps rising. * Gleason Score: 3+3 (2 of 6 specimens) 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. Low volume post-void residual urine is present in the bladder. The side effects of the cut, radiate, hormone regime are unacceptable to me. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). Dont Miss: Screening For Prostate Cancer Icd 10. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. Adenocarcinoma: Fear motivates you to want to treat this as soon as possible. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . Note respondents were able to choose more than one reason. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Negative cancer in lymph nodes, seminal vesicles, and all margins. Prostate, right medial apex: It will be interesting to see, I think. 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 pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. 2 cores from left base of 3+4=7 with only 5% involvement. * Asked and Dr. said he isn't overly concerned about perineural finding with the grade and it won't impact treatment options or overall prognosis. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. Benign Processes: 1. - Benign prostatic tissue You May Like: Prostate Cancer External Beam Radiation Side Effects. It hasn't let me down. Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Also Check: How Old Can You Be To Get Prostate Cancer.

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