-------------------------------------------------------- Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. 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. Experts believe that this study is the first in history to have achieved such results. But I've had trouble getting Dr. Chang's office to provide any patient referrals. And just this week, 1 YEAR post treatment, it is .46. 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. Extracapsular extension: The prostatic capsule is preserved. DRE is always normal. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Good Luck and God Bless everyone. Explore our state-of-the-art patient care facilities in the Sheikh Zayed Tower. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. Does every biopsy provide a Gleason Score? (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. In the mean time my PSA was movingno longer static, but never back up to 6. ADC: mean 879 / median 839 / st dev 223 If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. present in bladder. The https:// ensures that you are connecting to the Thanks, Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news. 7. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. PREVIOUS MRI RESULTS (LOTS of them) Possible additional organ confined malignant lesion in right apex For cancers that are less common, second opinions can offer more treatment options. Thanks to all of you for sharing! Good pathology readings require experience and a high level of expertise. But I refuse to sit still, I continue to research and to plan, as best I can. Both Drs and nurses knew what they were doing and had lots of experience. Therefore, the value of these second opinions remains unknown. This condition causes pain in the lower back and groin area, and may cause urinary retention. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. 9: Prostate, left anterior MRI lesion Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. Benign prostatic tissue 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. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. Finally, things are set and I know what is going to happen. Expert review of your case by a Cleveland Clinic specialist. Benign Processes: If the enlarged prostate is not completely removed, it will shrink. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. Also, their protocol would be another biopsy, but he was comfortable with the image and velocity of PSA that he didn't have to have one to start treatmentand I was pretty hesitant (given the image and PSA) to take ADT, and didn't see a biopsy changing my mind regarding treatment and/or ADT.Oh. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. One of the problems with second opinions is that insurers may not cover the expense. 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. The biopsy took 3 samples from the targeted region plus 16 sextant. Five years ago I had a TURP. Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. We will then prepare a written recommendation regarding your treatment plans or options. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. Recently diagnosed a Gleason 3 + 3. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. 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. I certainly would - after all, there's a certain brotherhood bond here. No extraprostatic extension. Seems like a simple request. 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. 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. 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. 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). Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. If I am rested, I find that I am more ready than if I am not. 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. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 1 of 2 cores (lateral core: 4 mm, 35%), 0.1 mm to the blue inked tissue edge 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. It's really that simple! Find more COVID-19 testing locations on Maryland.gov. There is no evidence FLA DONE AT FIRST BIOPSY G- 7. Your email address will not be published. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. * Prostate volume: 22 cc 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. 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%). Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. And it is OK to have paralysis by over-analysis. radiation, active surveillance, surgery, hormone therapy, and more. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: :) 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. * 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. Greetings gentlemen! I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. * Location: Left, anterior, base to apex, transition zone My goals are to control PCa, to minimize side effects, and to keep options open in the future. The percentage of tissue with carcinoma is 70% ZERO - The End of Prostate Cancer Support Community. A enlarged prostate can also cause blockages in the urethra. 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? Further, the two tumors in question have not really changed much in size for more than 2 years. Need guidance choosing from multiple treatment options. The linear amount of tissue with carcinoma is 23 mm Have been told a health condition is not treatable. PSA that brought me to this was 7.1. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. He recommended waiting and watching at that time due to the lower PSA reading. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. Just had my appointment today and they are pleased with the results, so far. Youve just been diagnosed 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! Prostate, right lateral base: I made the appointments. The side effects of the cut, radiate, hormone regime are unacceptable to me. I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. The .gov means its official. 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. Grade Group: 2 Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. 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. In the United States, prostate cancer is among the most common cancers found in men. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Thanks! I have posted here before, now with an update. Fear, confusion and uncertainty set in. 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 . 3: Prostate, right medial apex Depending on your location, you may be able to have a telemedicine consultation. My questions are: In fact, additional biopsies revealed no additional cancer. There is no extraprostatic extension. Benign fibromuscular stroma; no prostatic glands are identified What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! * PIRADS v2 Score: 3 F. Prostate, left apex, core biopsy: No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." - T2 = 3/5 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. And just this week, 1 YEAR post treatment, it is .46. 3. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. He is the past president of the International Society of Urological Pathology. 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 . I have actually had a second opinion a while back from Dr. Bush. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. In other words, the cancer is still contained within the prostate. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. National Library of Medicine In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . 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. Benign fibromuscular stroma; no prostatic glands are identified You have a rare or unusual cancer. How much is the fee for an opinion of my recent MRI? However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Unbelievable that this happened!!! While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. * Membranous urethral length: 1.2 cm 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. Fear motivates you to want to treat this as soon as possible. lesion. 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. According to the study, one in every 600 diagnoses showed mistakes.This study only addressed major changes in diagnoses, such as a diagnosis of cancer being reversed to no cancer, says Johns Hopkins pathologist George Netto, M.D. Dr. Dan Sperling - New York. Call us with any questions: 410-955-2405, ext. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Maybe lycopene and pomegranate have helped. So, I also sent this MRI result to Johns Hopkins for a second opinion. The average age at the time of prostate cancer diagnosis is about 66. Here are the details: BJU Int. Cancer 2017;123:1027-34. Methods: Contact us or find a patient care location. * Perineural Invasion detected - Johns Hopkins Medicine -- Get a Second Opinion They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. 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. I am doing one in 6 weeks, regardless. And 2 cores from left apex of 3+3=6 with 10% involvement. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. Medical record collection from doctors and hospitals. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". 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. They are not objective. 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. 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. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Find more COVID-19 testing locations on Maryland.gov. Some men have minimal or no symptoms at all. So, Radiation Oncologist prescribed Cialis 5mg, daily. 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. Immediate means 6 weeks just to see his NP. Benign prostatic tissue Read books and realize as soon as they are published, they are outdated. Dont Miss: Is Coffee Bad For Your Prostate. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. I luckily found this webpage and I started reading everything I could get my hands on. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. 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. It didnt look at changes of grading of the cancer.The chances for some type of modification based on a second opinion are even greater than the study indicated.Asking for a second opinion could lead to a significant change in surgical or medical intervention, Netto says.Even if the diagnosis error isnt catastrophic, such as advising a patient that he has cancer when he really doesnt, an error in grading can be consequential. Especially opinions other than those of the first Urologist you see. It is OK to be scared. Masks are required inside all of our care facilities. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. BONES: No suspicious osseous Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. An accurate diagnosis is essential to ensure the most effective treatment. How important is Oncotype DX test for Gleason 7? In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Generally, the symptoms can stabilize over time. My first PSA was 8.03. Over 80,000 specimen cases are seen at Johns Hopkins each year. The site is secure. We are vaccinating all eligible patients. For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. I had a follow up 3T MRI guided biopsy on March 18 at Emory. 4/16 3T MRI performed (reports/re-reads below) Generally, the symptoms can stabilize over time. Primary Gleason grade: 3 Covid turned the 1 year into 16 months and PSA tested at 7.44 in August 2020, followed by another referral back to the urologist. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive Anything I am overlooking or need to add to my list of considerations? Seminal vesicles are normal. I really liked the new group I went to as they identified the lesion right away, unlike the radiologist who performed the first procedure, and they also have a urologist on staff as well monitoring everything. 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. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. 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. 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? Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway.