The neurovascular bundles are intact. Some men have minimal or no symptoms at all. Any input on this would really be appreciated. Second Opinion For Cancer Treatment And Care | CTCA | City of Hope A second opinion is part of the education process that is critical for many cancer patients. Other: There is trace ascites in the mesosigmoid. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. I'm turning 58 in one week. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. JAMA Netw Open. We can help with your case. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? This fluid causes the prostate to swell and cause a number of bladder-related symptoms. 8600 Rockville Pike 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. The results were ambiguous. Please enable it to take advantage of the complete set of features! focal peripheral zone lesions. In the mean time my PSA was movingno longer static, but never back up to 6. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. The results of Oncotype came back and it was a bad report. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. EDI am now 52 and not quite functioning like I did 4+ years ago. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. Before 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. Im currently 67 years old. A fusion biopsy was performed in late May and I just received those results last Thursday. 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. 180 days after treatment PSA was .50. Confirm biopsy and imaging results with centers of excellence before making any final decisions. All views would be appreciated. 4/16 3T MRI performed (reports/re-reads below) But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. -------------------------------------------------------- Dont Miss: Is Coffee Bad For Your Prostate. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. Generally, the symptoms can stabilize over time. We experienced information overload and decision/analysis paralysis. 4. J Am Board Fam Med. It starts many years ago. 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. Anyone with insight into this and advice? -------------------------------------------------------- Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. In fact, additional biopsies revealed no additional cancer. Prostate Cancer: Symptoms, Causes & Treatment - Cleveland Clinic 1: Prostate, right lateral apex 2020 Dec 1;3(12):e2028320. 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. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. Contact us or find a patient care location. Read Also: What Are The Signs Of Prostate Infection. Second Opinions in Prostate Cancer - American Council on Science and Health If I am rested, I find that I am more ready than if I am not. Breast Cancer: When to Get a Second Opinion - WebMD Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. Best practices dictate that you obtain a second confirmatory pathology evaluation. "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 . I had two no-risk, non-invasive tests: a Free PSA with an adverse score of 9% and a PCA3 test with a disappointing 41. SMIL radiologist reported nothing found. I assume it is not free. I made the appointments. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. Find more COVID-19 testing locations on Maryland.gov. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) * Prostate size: 3.9 x 2.8 x 3. cm How could this compare using only partial slide re-reading? You can find out by reviewing your plan or by reaching out to your insurance company. 4. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. Symptoms include leaking and discomfort. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. 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. - High grade prostatic intraepithelial neoplasia (HGPIN) 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. There are also some cases of the test showing no depletion but being wrong. - High grade prostatic intraepithelial neoplasia (HGPIN) This teamwork ensures the best possible patient outcomes. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. (PZ) - normal 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. He said that it will improve in the future due to future improvements in the treatments. Slight BPH findings. Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. Pingback: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Pingback: Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Your email address will not be published. They replied they are sending the slides but they said they're looking into the DX test and will get back to me once they have that information. During puberty, the body produces semen in a large number of cases, including enlarged prostate. 2. Over kill and redundancy I know, but it's my money, my prerogative. 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. We will give that a shot and see how it turns out. 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. How much is the fee for an opinion of my recent MRI? 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? Other labs for second . It is OK to be overwhelmed with info. Have been told a health condition is not treatable. and transmitted securely. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? Good Morning Brothers- I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. Second opinions from urologists for prostate cancer: Who gets - PubMed Masks are required inside all of our care facilities. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. 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. Also, infection was noted, so the current PSA is high in part due to prostatitis. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. And should I treat prostatitis before FLA? Epub 2017 Jun 12. Johns Hopkins second opinion - nothing found. 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. In order to receive appropriate treatment, patients must understand the treatment options that are available. Have a condition that isnt improving or is getting worse, despite treatment. I can do radiation as a monotherapy. Expert review of your case by a Cleveland Clinic specialist. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): Move ahead to Dec 2020. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. One of the problems with second opinions is that insurers may not cover the expense. Not all cancers are the same and not all treatment plans are absolutely clear. Prostate cancer is a slow growing condition. Reasons for obtaining a second opinion from urologists. 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. Johns Hopkins Health - Second Opinions, Second Chances, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, High Blood Pressure May Take Its Toll on Your Kidneys. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. My mind goes all over the place as to why this is. 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. -------------------------------------------------------- Did robotic radical prostatectomy 1/25/12. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Blessings. Benign prostatic tissue present in bladder. Since I have gotten so much out of this forum, I thought Id provide my story to help others. the transition zone. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. If they have an enlarged colon, their physician can perform a TURP procedure. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive I'm trying to figure out why the PSA keeps rising. 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. Your doctor is not sure what is wrong with you. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. The primary goal is to be cured with the least toxic, most effective approach. official website and that any information you provide is encrypted 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. 180 days after treatment PSA was .50. That is literally the first time I heard that term other than seeing it in my pathology report. The site is secure. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. So the pathologist suggested a second opinion. We can help with your case. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. Depending on your location, you may be able to have a telemedicine consultation. Even if I go the radiation route, should I try for Proton radiation or some other type? -------------------------------------------------------- - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. It also rules out Brachytherapy. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. I've been on AS since April 2016. I would appreciate hearing from that 2.8% out there who have an intraductal component. Does every biopsy provide a Gleason Score? - DCE = (+) Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? Dont Miss: New Treatments For Stage 4 Prostate Cancer. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. F. Prostate, left apex, core biopsy: Tumor Quantifications: 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. 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. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Asking about other experience with conflicting Prostate Biopsy Opinions. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Unfortunately, monetary incentives create biases that can work against patients best interests. * Size: 1.1 cm And it is OK to have paralysis by over-analysis. Get directions, important phone numbers, locations and more. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. International Patients: How to Request a Remote Second Opinion 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. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. So I initially thought this makes me a good candidate for AS. probably organ confined disease. I am doing one in 6 weeks, regardless. Fear, confusion and uncertainty set in. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. One to a 3+4=7 and the other to a 3+3=6. Bring All Labs/Notes to Each Appointment. Prostate, right medial apex: Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. A blocked urethra can also damage the kidneys. According to the doctor it is around 3 mm. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. They are not objective. Find more COVID-19 testing locations on Maryland.gov. Thanks, Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. This condition causes pain in the lower back and groin area, and may cause urinary retention. I followed up with the original pathologist to compare and he was more forthcoming. Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists. A blocked urethra can also damage the kidneys. 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 . In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. Even at the age of 48, he thought I would be a good candidate for AS. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. They won't be offended, and they may even be able to recommend a specialist for you to see. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. Receiving a second opinion was not associated with perceived quality of prostate cancer care. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. Benign Processes: A week later had catheter removed and had no bladder leakage problems. But you have to do both. 8. In some situations, insurers will even insist on a second opinion. Spent the night in hospital with very little pain after the first couple of hrs. A doctor may prescribe surgery or perform an endoscopic procedure. 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." 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. Just had my appointment today and they are pleased with the results, so far. PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? Seek Perspective from a Range of Specialists. 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." The percentage of tissue with carcinoma is 70% Many researchers believe PTEN present is a strong brake on What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. How long do you have left? 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. Prostate, right lateral apex: 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. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". PSA that brought me to this was 7.1. Finally, things are set and I know what is going to happen. Medical record collection from doctors and hospitals. Your email address will not be published. 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. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. Getting A Second Opinion On Your Pathology Report - Cancer ABCs Oncologist. He was right. Expert review of your case by a Cleveland Clinic specialist. There is no extraprostatic extension. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. 2: Prostate, right lateral base 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. 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. THANKS! 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. Consultation with your nurse care manager. 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. 3: Prostate, right medial apex Recovery from Prostate Cancer | Bills Story. You may also complete an online appointment request form and we'll respond to schedule an appointment. - Johns Hopkins Medicine -- Get a Second Opinion I am 62 years old. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! We are vaccinating all eligible patients. MRI obtained outsideon 04/16/2021. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. So, I asked the Radiologist if she will schedule one for me. This teamwork ensures the best possible patient outcomes. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Anyway, would appreciate knowing how to contact Johns Hopkins. It is still important to do your own research. The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. My plan is to choose quality of treatment over cost of the treatment. ADC: mean 879 / median 839 / st dev 223 Therefore, the value of these second opinions remains unknown. A doctor may prescribe surgery or perform an endoscopic procedure. Greetings gentlemen! The linear amount of tissue with carcinoma is 23 mm Prostate volume: 17.58 cc -------------------------------------------------------- They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. (I must say that those low numbers concern me a bit.) EDI am now 52 and not quite functioning like I did 4+ years ago. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Prostate, left medial base: Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . No extraprostatic extension. Left mid-base transition zone (PIRADS 5). Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Comments appreciated, Then about a month later I started 28 fractions of Proton Radiation.It was painless. 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. Instead, I did my homework. Wondering if any of the "gurus" here want to take a stab at looking at this and see if they agree that it says what I think it says (I will be following up with doctor(s) to get their opinion, and I waive all HIPAA rights by allowing this to be seen). I am relatively new to this forum and trying to educate myself as to my best course of treatment.