We are vaccinating all eligible patients. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. Of course that was before I found this webpage and I really didn't know what 1 core of 18 samples showing 3+4=7 Gleason meant. Ozzieville (Michael), Hello All and thanks for being here~This is my first post.My husband was diagnosed with PC (adenocarcinoma with Extensive Intraductal Carcinoma Present) a few weeks ago. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. Right mid anterior transition zone (PIRADS 2). All wanted to do what they do, schedule treatment which at this time is only Gleason 6 which I now know is not life threating. The study was published online Nov. 7 in the journal Cancer. Netto says patients should be proactive in requesting that doctors take another look. One of the problems with second opinions is that insurers may not cover the expense. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. 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. The https:// ensures that you are connecting to the 5. Got my physical and normal DRE with new Dr. No issues identified. 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. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Thanks to all of you for sharing! But you have to do both. It will be interesting to see, I think. We will give that a shot and see how it turns out. There is no one-size-fits-all treatment for prostate cancer. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Prostate, right medial base: 9. 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? A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. So, I asked the Radiologist if she will schedule one for me. A doctor may prescribe surgery or perform an endoscopic procedure. Four had 60-70%, five have between 5-10%. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". 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. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. If these do not work, your symptoms could progress and become chronic. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. 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. Now, I would like to send Radiology for a similar review. Experts believe that this study is the first in history to have achieved such results. Because I had an implant in my ear, they would only give me a 1.5T MRI. After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. 53 years old If they have an enlarged colon, their physician can perform a TURP procedure. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. So off I went to see a community urologist who performed a needle biopsy in his office. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. 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. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? 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. Request an Appointment 410-955-6100 In addition to cancer, our urologic team provides second opinions regarding urinary stone disease, urinary tract reconstruction, incontinence, male infertility and sexual health, and many other urologic conditions or procedures. 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. I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 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. 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. Consultation with your nurse care manager. 6. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. probably organ confined disease. My long-term prognosis appears to be good with minimal side effects. Consult Fees In some cases, additional testing may be required. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. My questions are: 4. If pain is present, a digital rectal examination will reveal hard areas. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? So the pathologist suggested a second opinion. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. 2. Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. We specialize in minimally invasive treatments for prostate cancer such as: We place a high priority on sparing the nerves and tissue around the prostate whenever possible. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. National Library of Medicine 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). Even at the age of 48, he thought I would be a good candidate for AS. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Have a condition that isnt improving or is getting worse, despite treatment. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Treatment must be chosen based on stage and your My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. It is OK to be scared. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. I suggest for all that hear, "you have cancer" that you seek more opinions! I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. 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. However, that information will still be included in details such as numbers of replies. Lesion 1: Left mid-base transition zone. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. I wanted to keep my options open. Over 80,000 specimen cases are seen at Johns Hopkins each year. 1. You think another treatment might be available. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. All Gleason 6 (3+3). He wants me to begin the ADT around 5/1. Other: There is trace ascites in the mesosigmoid. It hasn't let me down. Some men may have an enlarged prostate but not notice it. Contact us or find a patient care location. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. Benign Processes: 3: Prostate, right medial apex My plan is to choose quality of treatment over cost of the treatment. My diagnosis is T2c, Gleason 7 (3+4). This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. 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. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Best wishes to all those whose concerns for the day are far more serious than mine. Either the patient or the primary physician can initiate the process of getting a second opinion. - 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 Be sure to confirm your diagnosis at a center of excellence. This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. * PIRADS v2 Score: 3 I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. 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. 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. * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project Thank you! And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) I still have some urgency and frequency issues, but I am not complaining too bad. JAMA Netw Open. Medical record collection from doctors and hospitals. 1. EDI am now 52 and not quite functioning like I did 4+ years ago. The total number of cores with carcinoma is 3 Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Epub 2010 Oct 20. 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. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. EDI am now 52 and not quite functioning like I did 4+ years ago. 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). Any input on this would really be appreciated. Careers. Maybe lycopene and pomegranate have helped. Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. Specimens Submitted: doi: 10.1002/cncr.30412. asymmetric central zone tissue more pronounced on the left. 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. 3. If these do not work, your symptoms could progress and become chronic. PI-RADS v2 score: 5. Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems. Only took Motrin and Tylenol for pain after release. An increase of 1.1 in 3 months is not good news. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. 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." This urologist can get you in for surgery next week. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length 3T MRI with coil is done initially, along with a TRUS biopsy. I retested in January 2019 and scored 4.20. I worked out every day. 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . I retired as a Dentist at the VA and saw many veterans with a wide range of outcomes as most of them became 100% service connected when diagnosed with prostate Ca due to exposure to Agent Orange if they served in Vietnam. Noted that some don't even include on report and should be looked as something to note but not obsess about. The neurovascular bundles are intact. Patients may experience a fever or chills as a result of the infection. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. 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. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. Bookshelf Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. * Perineural Invasion also detected A newly published paper by Fischer et al. Masks are required inside all of our care facilities. Thank you! government site. Based on the results, our experts can provide you with an individualized treatment plan before you leave. All views would be appreciated. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. Accessibility You may also complete an online appointment request form and we'll respond to schedule an appointment. First 6 week PSA is undetectable. 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. 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. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Atrophy Good pathology readings require experience and a high level of expertise. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. Some pathologists have more experience than others. 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 . __________________________________________________________________________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. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Request an Appointment 410-955-6100 5. Johns Hopkins is home to many of the world's leaders in Pathology. This condition causes pain in the lower back and groin area, and may cause urinary retention. 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. My strong preference would be to do FLA again and monitor. Treatment options include immunotherapy, John, I was diagnosed on 11 December, 2013. Other Features: In order to receive appropriate treatment, patients must understand the treatment options that are available. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. It works. Yet none of my doctors ever mentioned it! Did robotic radical prostatectomy 1/25/12. And just this week, 1 YEAR post treatment, it is .46. Also, infection was noted, so the current PSA is high in part due to prostatitis. ---------------------------------------------------- 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. We have a consult on Friday with the 1st opinion doc to review all tests. 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. The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). I had a follow up 3T MRI guided biopsy on March 18 at Emory. :) Also these lesions did not abut or touch the wall of the prostate. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. A biopsy was performed on 2/26. Benign fibromuscular stroma; no prostatic glands are identified Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. My new Dr however didnt order PSA so I asked him for one. More medical freakouts. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. They agreed with the PI-RADS 4. Johns Hopkins second opinion - nothing found. Who Should Request a Second Opinion? That said, I have some questions that I derived, keeping in mind that 99% of what I have learned since February has come directly from this group: Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. Director of Surgical Pathology- Johns Hopkins, http://pathology.jhu.edu/department/services/secondopinion.cfm, The guy I used along with everyone else is Jonathan Epstein, M.D. Reasons for getting a second opinion include: You want to be sure you have explored all options. We are vaccinating all eligible patients. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. 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. I just received a second opinion report from Johns Hopkins. I appreciate any comments or insight that anyone wants to share. An official website of the United States government. Grade Group: 1 6. He said that it will improve in the future due to future improvements in the treatments. Disclaimer. Do I need a third opinion? We are vaccinating all eligible patients. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . 2020 Dec 1;3(12):e2028320. What have your doctors told you? Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Also Check: How Old Can You Be To Get Prostate Cancer. G. Prostate, lesion #1, core biopsy: Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. Lesion 2: Right mid anterior transition zone. Dont Miss: Screening For Prostate Cancer Icd 10. I am unfortunately "officially" joining the club after getting my biopsy results today. Assessment categories for this lesion: Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. 7: Prostate, left lateral apex It was easy. * Adjacent organ invasion: None. 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. undefined will no longer be visible to you including posts, replies, and photos. Benign prostatic tissue Younger men also sought the 'best' doctor. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. 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. 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 . After all, it seems like good idea to deal with your cancer sooner rather than later. Your email address will not be published. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. present in bladder. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. Federal government websites often end in .gov or .mil. My question is--what importance do volume levels play in determining when to move from AS to treatment? This teamwork ensures the best possible patient outcomes. You can call and speak with his assistant at: (410) 614-6330. With that alone, I would likely be a candidate for continued Active Surveillance. That being said, they can be a beneficial member of the treatment team. You're at greater risk if you're Black or of African ancestry.
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