I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. The study was published online Nov. 7 in the journal Cancer. After all, it seems like good idea to deal with your cancer sooner rather than later. ---------------------------------------------------- Wow, I sound like a snob now! ORIGINAL MRI REPORT (local radiology group): In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. I had my first of those 2 PSA tests last week and it dropped to 4.77. Pathology reports are subjective. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? Allow yourself the time to seek multiple opinions. Treatment options include immunotherapy, I'm 58 yrs old and had a TRUS random biopsy October 2020 after my PSA continually stayed between 4.4 and 8, and PHI score was 126. Grade Group: 2 It was easy. Every year I got a PSA and DRE during my annual physical. This is often the case when the primary physician advises an expensive treatment. This is not true. Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. Types of questions that pathologists often address in our second opinions: Seek Perspective from a Range of Specialists. And thanks again for making this such a great support group! While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Benign Processes: mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. Luckily, his report co-coincided with the original QDx report. Receiving a second opinion was not associated with perceived quality of prostate cancer care. Getting a second opinion from us is easy, convenient, and all done remotely. When to move from Active Surveillance to Treatment for Prostate Cancer? Many thanks for that. 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. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. My plan is to choose quality of treatment over cost of the treatment. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. (I must say that those low numbers concern me a bit.) Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. So, I asked the Radiologist if she will schedule one for me. Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri Getting a Second Opinion The best time to seek a second opinion is before you start treatment. 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. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Recovery from Prostate Cancer | Bills Story. Seminal vesicles are normal. 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'm going to reach out to UCLA to see what they can do. Same with the amount of how much pattern 4. 3. According to The National Institute on Aging, prostate problems are common after age 50. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? They find that one of my 5-10% Gleason 6 core is actually a 50% Gleason 7(3+4) and the MRI was so cloudy with blood from original biopsy they said they couldnt determine much. 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. Symptoms include leaking and discomfort. restricted diffusion. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. Surprisingly, while one in nine men will get diagnosed with prostate cancer in their lifetime1, there are very few doctors who specialize exclusively in treating prostate cancer. Younger men also sought the 'best' doctor. I was on active surveillance after a FLA procedure done in 2018. Surgeon wants next PSA in 3 months. 4. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Your doctor is not a specialist in your type of . I assume it is not free. It starts many years ago. 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. 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. Getting a second opinion can sometimes lead to a complete change in diagnosis (such as cancerous to benign or vice versa) in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. Benign Processes: Patients may experience a fever or chills as a result of the infection. doi: 10.1002/cncr.30412. * Prostate size: 3.9 x 2.8 x 3. cm -------------------------------------------------------- Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. So my question for you is have you ever heard of PRECISE and if so what should I make of it? A biopsy was performed on 2/26. Note respondents were able to, MeSH And again, most of you tell me time is on my side, so I am comforted in hearing that. Here are seven tips for seeking second opinions for prostate cancer: Before getting a second opinion, its important to know your stage of prostate cancer. Since I have gotten so much out of this forum, I thought Id provide my story to help others. I'm turning 58 in one week. Both Drs and nurses knew what they were doing and had lots of experience. 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. A second opinion can help you make an informed, confident decision about your medical care. THANKS! I am 65 and in excellent general health. Conclusions: Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. About this time, I started reading this forum and my ignorance starts going away. More medical freakouts. 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). Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. So, Radiation Oncologist prescribed Cialis 5mg, daily. Following the advice of all on here, I need a team of doctors to manage my care. MEASUREMENTS: 5: Prostate, left medial apex 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. 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. In order to receive appropriate treatment, patients must understand the treatment options that are available. 1st opinion"Note is made of sclerotic changes in the right pubic bone adjacent to the symphysis pubis having only low-level activity and this is thought to be more likely due to degenerative changes rather than bony metastasis." Also, infection was noted, so the current PSA is high in part due to prostatitis. Cancer 2017;123:1027-34. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. 9. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. A blocked urethra can also damage the kidneys. Good Luck and God Bless everyone. desired outcome. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. Second opinions offer different things in different circumstances, Dr. Matasar says. 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. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. 3: Prostate, right medial apex My question is--what importance do volume levels play in determining when to move from AS to treatment? Prostate cancer is an HHS Vulnerability Disclosure, Help The issues in my prostate from the first procedure onward have all been in the same area and the rest of my prostate from the first biopsy and subsequent MRIs onward have never shown any indications of cancer in other areas. * Gleason Score: 3+3 (2 of 6 specimens) 3. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. Spent the night in hospital with very little pain after the first couple of hrs. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. !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. Unable to load your collection due to an error, Unable to load your delegates due to an error. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. prostate volume). I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. There is no one-size-fits-all treatment for prostate cancer. He also stated that he would ONLY recommend FLA if done within a trial. Left mid-base transition zone (PIRADS 5). I am 58 and in very good health otherwise. In some situations, insurers will even insist on a second opinion. I now have my list whittled down to 3. - Johns Hopkins Medicine -- Get a Second Opinion Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. I had FLA done after first biopsy which staged me at 3+4 = 7. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. If I am rested, I find that I am more ready than if I am not. I suggest for all that hear, "you have cancer" that you seek more opinions! Secondary Gleason grade: 4 Diffuse probable benign peripheral zone changes limit evaluation for Two weeks later I meet with my Johns Hopkins Dr. So, I also sent this MRI result to Johns Hopkins for a second opinion. 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. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (combined: 10.5 mm, 40%), 0.2 mm to the blue inked tissue edge Benign Processes: And just this week, 1 YEAR post treatment, it is .46. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Seems like a simple request. 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. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". * Seminal vesicle invasion: None. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! Conflicting Prostate Biopsy OpinionsWhat to Do? You He wants me to begin the ADT around 5/1. If anyone has used him, please let me know what your experience was like. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. 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. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. 180 days after treatment PSA was .50. Only took Motrin and Tylenol for pain after release. Secondary Gleason grade: 3 Suspicion for malignancy left anterior base-to-apex transition zone; Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. How much is the fee for an opinion of my recent MRI? The biopsy took 3 samples from the targeted region plus 16 sextant. DRE is always normal. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. BJU Int. 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. Ask your doctor for a copy of your complete medical record. PMC At Johns Hopkins, you can feel confident knowing our multidisciplinary cancer clinics combine the very best resources and specialists all within in a single location for a highly coordinated experience that delivers exceptional care while conserving time, money and energy. Especially opinions other than those of the first Urologist you see. 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. We can help with your case. Sometimes, you may find out about treatment options you didnt know were available. My diagnosis is T2c, Gleason 7 (3+4). World J Urol. This is a PI-RADS 5 lesion in A fusion biopsy was performed in late May and I just received those results last Thursday. Prostate Cancer Grading: The majority had lower risk tumors and clinical staging of 1 40% sought second opinions with about half having more than one reason Men seeking second opinions tended to be younger and better educated citing the need for more information as their reason. Johns Hopkins Health - Second Opinions, Second Chances, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, High Blood Pressure May Take Its Toll on Your Kidneys. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. Last year, Epsteins lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions.Netto says patients should be proactive in requesting that doctors take another look.A second opinion can reverse the diagnosis in up to 5 percent of cases for some types of cancers, he says, like those of the breast and pancreas.Diagnosis Errors by the Numbers. I have posted here before, now with an update. 1. So the pathologist suggested a second opinion. 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 . - PI-RADS for this lesion = 4/5 This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. Adenocarcinoma: - T2 = 3/5 You May Like: Sbrt Radiation Therapy Prostate Cancer. Noted that some don't even include on report and should be looked as something to note but not obsess about. 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. Bladder: Normal. Expert review of your case by a Cleveland Clinic specialist. Oncologist. It hasn't let me down. 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. Extraprostatic extension: negative Got my physical and normal DRE with new Dr. No issues identified. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. C. Prostate, right apex, core biopsy: 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. If I am rested, I find that I am more ready than if I am not. There are also many reasons why you may want to seek another opinion during the course of your cancer care. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. You're at greater risk if you're Black or of African ancestry. Methods: Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. Prostatic Adenocarcinoma Asking for your comments: With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. 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. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. Anyone else encounter something like this? Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. 1. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Masks are required inside all of our care facilities. Potentially inaccurate results can lead to selection of the wrong type of therapy. So the pathologist suggested a second opinion. Now, I would like to send Radiology for a similar review. We are vaccinating all eligible patients. 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. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. 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. I was referred to a urologist and tested again in April at 4.40. and I have already proven to myself that my body is good at cell mutation, so I wanted to be careful.At the 3 year mark (6 months after last MRI), my PSA spiked to > 6. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Prostate, right lateral apex: * Extracapsular extension: Possible involvement of the anterior * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. Johns Hopkins is home to many of the world's leaders in Pathology. It has been 2.5 years and the PSA has still not doubled as well. Am I missing anything? PSA had increased to 5.4. Greatest dimension 2cm. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. We have sought a second opinion and all tests are being reviewed by that second team.My question has to do with the symphysis pubis. advising or treating it. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! 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). Caused me to bleed heavily. Slightly I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. Finally, things are set and I know what is going to happen. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. )As for side effectsI occasionally have some urgency/hesitancy having to pee. BONES: No suspicious osseous I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. It got discussions started and questions answered. Need guidance choosing from multiple treatment options. Benign prostatic tissue Your email address will not be published. There are also many reasons why you may want to seek another opinion during the course of your cancer care.
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