johns hopkins prostate cancer second opinion

This is a PI-RADS 5 lesion in However, learning more about prostate cancer and prostate-related health issues can help optimize health. Second opinions offer different things in different circumstances, Dr. Matasar says. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): Those readings were reported on a second opinion by Dr. Epstein. Some men may have an enlarged prostate but not notice it. I worked out every day. advising or treating it. A blocked urethra can also damage the kidneys. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. For cancers that are less common, second opinions can offer more treatment options. A report with the diagnosis will be faxed to your doctor. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Unfortunately, what you do not realize may harm you! 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. Not all cancers are the same and not all treatment plans are absolutely clear. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. - High grade prostatic intraepithelial neoplasia (HGPIN) Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. A enlarged prostate can also cause blockages in the urethra. Does every biopsy provide a Gleason Score? Thanks, BigD. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. The side effects of the cut, radiate, hormone regime are unacceptable to me. I officially joined the club with diagnosis on March 21: three small lesions with a GS 6 on one side and both a GS 6 and a GS (3+4) 7 on the other side. Based on the results, our experts can provide you with an individualized treatment plan before you leave. decision on a single medical opinion or the first appointment you get, you may 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. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. I personally have benefitted from second opinions on my so-called cancer journey. I was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. - 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) Masks are required inside all of our care facilities. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. Also Check: Prostate Cancer Stage 7 Treatment. Get a Second Opinion Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. 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. My diagnosis is T2c, Gleason 7 (3+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. 7 in 10 PATIENTS WHO GET A SECOND OPINION AT CTCA CHOOSE TO TREAT WITH US Call now to find out why: 800.888.8888 Rosie P. Colorectal Cancer 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. We will give that a shot and see how it turns out. Find more COVID-19 testing locations on Maryland.gov. Especially opinions other than those of the first Urologist you see. Video consultation and written report from your expert. Second opinions offer different things in different circumstances, Dr. Matasar says. 1. Total Gleason score: 6 So, I believe I made the right choice. Got my physical and normal DRE with new Dr. No issues identified. My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. Dont Miss: Screening For Prostate Cancer Icd 10. MM, Much to my dismay my 4th targeted biopsy Oct 12 revealed 5% G4 (upgraded from Grade Group 1 to 2 (Gleason 3+4 intermediate/favorable). Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. 2: Prostate, right lateral base ORIGINAL MRI REPORT (local radiology group): Read books and realize as soon as they are published, they are outdated. For cancers that are less common, second opinions can offer more treatment options. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. 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. Prostate, right anterior MRI lesion: Medical record collection from doctors and hospitals. Types of questions that pathologists often address in our second opinions: Conflicting Prostate Biopsy OpinionsWhat to Do? In the mean time my PSA was movingno longer static, but never back up to 6. If I am rested, I find that I am more ready than if I am not. And it is OK to have paralysis by over-analysis. Discover what's to love about Charm City for yourself. 9: Prostate, left anterior MRI lesion undefined will no longer be visible to you including posts, replies, and photos. Benign Processes: Bladder: Normal. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. Details are here: Other labs for second . Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. 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. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. the transition zone. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. Prostate Cancer Grading: My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. Notice of Privacy Practices(Patients & Health Plan Members). I now have my list whittled down to 3. MRI RE-READ #2 (VERY VERY well respected radiologist): Urology. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. 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. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. You think your doctor is underestimating how serious your cancer is. 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 . -------------------------------------------------------- - T2 = 3/5 About this time, I started reading this forum and my ignorance starts going away. 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. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. I was referred to a urologist and tested again in April at 4.40. Benign Processes: He also stated that he would ONLY recommend FLA if done within a trial. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. 4. doi: 10.1001/jamanetworkopen.2020.28320. 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. Same with the amount of how much pattern 4. I retested in January 2019 and scored 4.20. The neurovascular bundles are intact. They agreed with the PI-RADS 4. Specimens Submitted: 2. JHs just said it was minimal less than 5%. It hasn't let me down. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. 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%). My PSA over time has been creeping up over time (1.8 - 5/16, 1.0 8/17, 2.68 8/18, 2.9 12/18, 3.28 2/19, 3.01 8/19, 3.65 2/20, 3.31 6/20, 3.88 12/20) but I was frankly a bit shocked when I received word that I have cancer. * Gleason Score: 3+3 (2 of 6 specimens) If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. Hello. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Would you like email updates of new search results? Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." I would appreciate hearing from that 2.8% out there who have an intraductal component. Clipboard, Search History, and several other advanced features are temporarily unavailable. Do I need a third opinion? This is often the case when the primary physician advises an expensive treatment. 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. Prostate Cancer: Symptoms, Causes & Treatment - Cleveland Clinic Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. Your doctor is not a specialist in your type of . Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . 7 Tips for Seeking Second Opinions For Men with Prostate Cancer What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! 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. Benign Processes: A enlarged prostate can also cause blockages in the urethra. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." Patients may experience a fever or chills as a result of the infection. My long-term prognosis appears to be good with minimal side effects. Want confirmation about a diagnosis or treatment. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. Some specialists have more expertise and more experience than others. He recommended waiting and watching at that time due to the lower PSA reading. They are not objective. - Benign prostatic tissue Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Finally, things are set and I know what is going to happen. Even at the age of 48, he thought I would be a good candidate for AS. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. E. Prostate, left mid, core biopsy: Instead, I did my homework. After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). Many thanks for that. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. 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. It got discussions started and questions answered. Therefore, the value of these second opinions remains unknown. He also said perinueral invasion, but not extracapsular extension. Pathology Second Opinion-J.Epstein,M.D. Pathologist-Johns Hopkins Ask us questions on this webpage. 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). Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. Benign Processes: If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. Prostate, right medial base: Also indicated everything else was "organ confined." This urologist can get you in for surgery next week. Consultation with your nurse care manager. Generally, the symptoms can stabilize over time. 7. -------------------------------------------------------- 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. Reasons for obtaining a second opinion from urologists. THANKS! Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. I appreciate any comments or insight that anyone wants to share. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? This fluid causes the prostate to swell and cause a number of bladder-related symptoms. Dr. Nour - Emory in Atlanta. 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. 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. 1: Prostate, right lateral apex Greetings gentlemen! Getting a Second Opinion The best time to seek a second opinion is before you start treatment. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. I'm turning 58 in one week. 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. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. 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. Im immediately referred to Urologist. My question is--what importance do volume levels play in determining when to move from AS to treatment? Hello everyone. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. Primary Gleason grade: 3 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion * Location: Left, anterior, base to apex, transition zone Ask us questions on this webpage. 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. HHS Vulnerability Disclosure, Help 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. How could this compare using only partial slide re-reading? World J Urol. Consultation with your nurse care manager. Benign prostatic tissue Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. How important is Oncotype DX test for Gleason 7? His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. The linear amount of tissue with carcinoma is 23 mm PI-RADS v2 score: 5. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. If they have an enlarged colon, their physician can perform a TURP procedure. John. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. The people were great. I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. Most choose treatment they originally planned to follow, study finds. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. A new study by researchers at the Johns Hopkins University has found that . 1. No extraprostatic extension. My urologist suggested a couple more PSA tests followed by an MRI. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. Brachytherapy Experience with Dr. Albert Chang at UCLA? - PI-RADS for this lesion = 4/5 PMC Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. * Prostate volume: 22 cc I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. What are you doing about it? It will be interesting to see, I think. We can help with your case. BASE DATA: I was confident I was making the right decision. PSA had increased to 5.4. Call us with any questions: 410-955-2405, ext. While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). At that point I agreed to the TRUS biopsy which I had on October 10, 2020. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. Bookshelf 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. 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. Luckily, his report co-coincided with the original QDx report. -------------------------------------------------------- 6: Prostate, left medial base Know Your Stage. As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. Find more COVID-19 testing locations on Maryland.gov. John Hopkins Prostate Cancer Second Opinion



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