Move ahead to Dec 2020. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Epub 2018 Mar 28. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? Enter the last name, specialty or keyword for your search below. A biopsy was performed on 2/26. 1. This is not true. I was confident I was making the right decision. 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. Consultation with your nurse care manager. 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. I don't know if the FLA could affect the results, or if it was just done because it was not in the study parameters of the test. PELVIC LYMPH NODES: No adenopathy. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. I'm trying to figure out why the PSA keeps rising. Our team approach brings together highly experienced prostate cancer experts from across disciplines to collaborate on each patients total care, from diagnosis through treatment and recovery. Prostate Cancer Grading: Yet none of my doctors ever mentioned it! Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. Now its easier than ever to get the answers you need and peace of mind you deserve. You feel healthy, you arent in pain, you She put me in the hospital. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. Prostate cancer is the second-most diagnosed cancer in American men. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. 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 . If pain is present, a digital rectal examination will reveal hard areas. official website and that any information you provide is encrypted He basically said it was possible, but that he did not agree. So my question for you is have you ever heard of PRECISE and if so what should I make of it? We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Thanks, BigD. Brief MRI history. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. 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. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . * Other 12 slides not sent He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. In severe cases, a catheter may be required to relieve the symptoms. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. 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. The .gov means its official. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. 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." - Benign prostatic tissue But I've had trouble getting Dr. Chang's office to provide any patient referrals. Medical record collection from doctors and hospitals. Epub 2017 Jun 12. I still have some urgency and frequency issues, but I am not complaining too bad. fibromuscular stroma, anterior prostatic contour is smooth. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. The biopsy took 3 samples from the targeted region plus 16 sextant. 2: Prostate, right lateral base After applying exclusion criteria, the final analytic cohort included 2365 respondents. Sometimes, you may find out about treatment options you didnt know were available. 5. This condition causes pain in the lower back and groin area, and may cause urinary retention. It works. There are lots of lessons learned on the forum. My urologist has decided we'll go ahead with the MRI due to the continued elevated PSA scores, in addition to the overall PHI score. "We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer," said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in . Some men will have a very enlarged prostate, whereas others will have a mild enlargement. When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. * Size: 1.1 cm I was confident I was making the right decision. So, Radiation Oncologist prescribed Cialis 5mg, daily. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. 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. DIAGNOSIS: There are also many reasons why you may want to seek another opinion during the course of your cancer care. 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. SMIL radiologist reported nothing found. * Adjacent organ invasion: None. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. 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. 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%). However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. 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. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. John. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? You may also complete an online appointment request form and we'll respond to schedule an appointment. 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. 180 days after treatment PSA was .50. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. decision on a single medical opinion or the first appointment you get, you may Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . According to the doctor it is around 3 mm. However, something is driving my PSA. Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. BJU Int. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". It starts many years ago. Family history of prostate cancer. You have a rare or unusual cancer. 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. 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 can help with your case. Make an appointment: 410-955-5222 Coordinating with your Treating Physician 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. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. Check Biopsy and Imaging Results for Accuracy. An increase of 1.1 in 3 months is not good news. 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. ---------------------------------------------------- In order to give treatment for each patient with utmost security we would like to announce that currently there will be no visitors allowed.Please note that only one attendant per in-patients is permitted. - T2 = 3/5 I'm turning 58 in one week. PSA that brought me to this was 7.1. One of the problems with second opinions is that insurers may not cover the expense. These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. 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. (Recommended by my oncologist, Dr. Mark Scholz.) There is no one-size-fits-all treatment for prostate cancer. A second opinion is part of the education process that is critical for many cancer patients. 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." T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. Just got my pathology results. Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. Do any of you have an opinion or actual experience with any of the three listed below? -------------------------------------------------------- Masks are required inside all of our care facilities. 4. Benign prostatic tissue We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. He wants me to begin the ADT around 5/1. No extraprostatic extension. Thank you for your understanding and cooperation. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. Then about a month later I started 28 fractions of Proton Radiation.It was painless. This condition causes pain in the lower back and groin area, and may cause urinary retention. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. Reinterpretation of imaging scans and lab tests. Greatest dimension 0.7cm . 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. 1. Seek Perspective from a Range of Specialists. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. Masks are required inside all of our care facilities. Prostate cancer is a slow growing condition. 1. I understand that patient privacy is a priority (I'm actually a privacy lawyer), but surely there are patients who would give consent and be happy to talk with a prospective patient about their experiences? The symptoms of acute bacterial prostatitis are similar to those of CPPS. Treatment must be chosen based on stage and your They agreed with the PI-RADS 4. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. For cancers that are less common, second opinions can offer more treatment options. 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. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. Over 80,000 specimen cases are seen at Johns Hopkins each year. 2. 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. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. In fact, additional biopsies revealed no additional cancer. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. Studies show the clinical and financial benefits of obtaining a pathology second opinion. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! Prostate, left lateral base: Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) Reasons for obtaining a second opinion from urologists. Grade Group: 2 intricate disease and not all doctors have the same amount of experience I was on active surveillance after a FLA procedure done in 2018. All views would be appreciated. * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project We will give that a shot and see how it turns out. A week later had catheter removed and had no bladder leakage problems. 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 total number of cores identified is 3 If anyone has used him, please let me know what your experience was like. In the United States, studies estimate 72 new cases of PN for every 100,000 people between the ages of 18 and 64 years old. MY THOUGHTS AND ANYTHING DOCTOR NOTED: In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Now, I would like to send Radiology for a similar review. This is why the prostate is important to the body. The out-of-pocket cost may be in the $300 range (insurance may not cover it), and it is a simple matter to call your urologist to forward the slides to them. Just took time off and then life happened.Thanks in advance for the insights. Conflicting Prostate Biopsy OpinionsWhat to Do? Prostate, left anterior MRI lesion: Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Hope to hear from a bunch of people. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. 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. 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. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. You May Like: Prostate Cancer External Beam Radiation Side Effects. I didn't study for the test and it's possible some morning activities might have affected my test score :) Greatest dimension 2cm. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. And 2 cores from left apex of 3+3=6 with 10% involvement. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. In severe cases, a catheter may be required to relieve the symptoms. It is OK to be scared. F. Prostate, left apex, core biopsy: 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). Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. I wanted to keep my options open. Prostate, right lateral base: Oncologist. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. 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. He said that it will improve in the future due to future improvements in the treatments. 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. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. I worked out every day. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. 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. sharing sensitive information, make sure youre on a federal I guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? Hillen MA, Medendorp NM, Daams JG, Smets EMA. I hope my story helps anyone out there just starting the process. Even at the age of 48, he thought I would be a good candidate for AS. I now have my list whittled down to 3. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This may include imaging, blood tests, prior treatment, and pathology reports. - DCE = (+) There is no evidence 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. Not all cancers are the same and not all treatment plans are absolutely clear. 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. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. I followed up with the original pathologist to compare and he was more forthcoming. Secondary Gleason grade: 4 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. A report with the diagnosis will be faxed to your doctor. Assessment categories for this lesion: T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive Either the patient or the primary physician can initiate the process of getting a second opinion. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Lesions are all small or very small. 3. Thankfully, prostate cancer is extremely slow growing. Can it be salvaged or are the risks of cancer too high? Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. First 6 week PSA is undetectable. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. About this time, I started reading this forum and my ignorance starts going away. 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 . It hasn't let me down. The presence of any G4 has been my trigger to seek treatment. However, there were no other suspicious areas on MRI. 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. Good pathology readings require experience and a high level of expertise. World J Urol. 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. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. 2. Intensity: min 148 / Max 459 Caused me to bleed heavily. Benign Processes: It took me awhile but minutes ago received my second opinion from Johns Hopkins. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) 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. The linear amount of tissue with carcinoma is 23 mm It also rules out Brachytherapy. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. (Scores above 55 have a greater than 50% chance of finding clinically significant cancer on a biopsy) The biopsy showed 2 or 3 cores containing HG PIN but no cancer. Adenocarcinoma:

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