Would you like email updates of new search results? My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. Extracapsular extension: The prostatic capsule is preserved. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Slight BPH findings. Methods: (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. Negative cancer in lymph nodes, seminal vesicles, and all margins. There are also many reasons why you may want to seek another opinion during the course of your cancer care. - DCE = (+) Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. We can help with your case. Note respondents were able to choose more than one reason. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): prostate volume). A total of 2386 men responded to the survey (adjusted response rate, 51.1%). Benign fibromuscular stroma; no prostatic glands are identified Generally, the symptoms can stabilize over time. 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. Best wishes to all those whose concerns for the day are far more serious than mine. Greatest dimension 2cm. However, a new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice or the persons perception of the quality of care they receive, at least among low-risk men. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Here are seven tips for seeking second opinions for prostate cancer: Before getting a second opinion, its important to know your stage of prostate cancer. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. The lesion also shows focal increased permeability. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Prostate, left medial base: I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive 4/16 3T MRI performed (reports/re-reads below) Surgeon wants next PSA in 3 months. Over 80,000 specimen cases are seen at Johns Hopkins each year. Its in your best interest to ask for another look at a cancer diagnosisIf youve recently been diagnosed with cancer, its wise to ask for a second opinion on your pathology specimen.Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause. 24.5 BMI Masks are required inside all of our care facilities. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. Dont Miss: Bladder Control After Prostate Surgery. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. I was diagnosed with a 3T MP MRI and a 3T MP MRI guided 4 core biopsy. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues. Therefore, the value of these second opinions remains unknown. 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. I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. The primary goal is to be cured with the least toxic, most effective approach. - 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 It also rules out Brachytherapy. There are so many different departments at Hopkins that I don't know the optimal department to contact. My family physician for years told me that small increases PSA was common so when it went over 4 it didnt bother me and my Dr who was retiring, didnt say anything either. The symptoms of acute bacterial prostatitis are similar to those of CPPS. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. 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. We are vaccinating all eligible patients. Please enable it to take advantage of the complete set of features! I am 58 and in very good health otherwise. The linear amount of tissue with carcinoma is 11 mm So the pathologist suggested a second opinion. A PSA test at time of biopsy revealed my PSA had risen to 6.5. Please don't hesitate to make any observations or ask questions. I would love to hear from anyone who has been involved in the Chicago study. not hear all the viable treatment options or receive the most up to date I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. The biopsy took 3 samples from the targeted region plus 16 sextant. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. Seminal vesicles and other margins are negative for tumor. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. Unfortunately, monetary incentives create biases that can work against patients best interests. Original Sloan Biopsy Results: Your doctor is not sure what is wrong with you. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. 4. 180 days after treatment PSA was .50. 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. Anything I am overlooking or need to add to my list of considerations? I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. During puberty, the body produces semen in a large number of cases, including enlarged prostate. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. 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." Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. 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. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. 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. 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. Based on the results, our experts can provide you with an individualized treatment plan before you leave. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? We are vaccinating all eligible patients. Read Also: What Are The Signs Of Prostate Infection. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). Finally, things are set and I know what is going to happen. You can find out by reviewing your plan or by reaching out to your insurance company. 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. If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. So I initially thought this makes me a good candidate for AS. G. Prostate, lesion #1, core biopsy: My plan is to choose quality of treatment over cost of the treatment. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. MRI RE-READ #2 (VERY VERY well respected radiologist): ADC: mean 879 / median 839 / st dev 223 Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. Overall my PSA is between 4 and 10. (I must say that those low numbers concern me a bit.) - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (combined: 10.5 mm, 40%), 0.2 mm to the blue inked tissue edge 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. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Transurethral microwave thermotherapy : In selected patients, microwave energy helps to restructure prostate tissue and alleviate symptoms such as incontinence and voiding dysfunction, 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. Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could have a significant impact on treatment and prognosis. It would be more convenient to use Mayo but I want the best practitioner regardless. It can: Confirm your original diagnosis and treatment plan Give you more detail about the type of breast cancer you have and stage it's in. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Allow yourself the time to seek multiple opinions. BONES: No suspicious osseous information. Do any of you have an opinion or actual experience with any of the three listed below? 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! It is OK to be overwhelmed with info. official website and that any information you provide is encrypted He was right. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Johns Hopkins second opinion - nothing found. You have a rare or unusual cancer. 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. After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. Should You Exercise When Youre Expecting? 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. Call us with any questions: 410-955-2405, ext. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. I wanted to keep my options open. Prostate, right lateral base: Cancer. 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. One of the problems with second opinions is that insurers may not cover the expense. However, something is driving my PSA. It is OK to not understand all the terminology. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. I suggest for all that hear, "you have cancer" that you seek more opinions! Are considering a treatment that involves significant risks, such as surgery. Recovery from Prostate Cancer | Bills Story. Men need to be educated on all treatment options to protect themselves from a biased industry. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Unfortunately, what you do not realize may harm you! Request an Appointment 410-955-6100 There are also many reasons why you may want to seek another opinion during the course of your cancer care. Other labs for second . EDI am now 52 and not quite functioning like I did 4+ years ago. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. present in bladder. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. 8600 Rockville Pike Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. 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. Some men have minimal or no symptoms at all. Be sure to confirm your diagnosis at a center of excellence. An increase of 1.1 in 3 months is not good news. Find more COVID-19 testing locations on Maryland.gov. 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. More medical freakouts. In general, a second opinion is a good option for people who have recently received a cancer diagnosis but have not started treatment, as well as for people who have already completed chemotherapy or radiation treatment. ---------------------------------------------------- And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Especially opinions other than those of the first Urologist you see. On the first scan (post FLA) a lesion was identified by the local radiologist that performed the scan, but the FLA radiologist that performed my procedure was over reading and monitoring my care and stated strongly that there was no cancer. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. Reasons for obtaining a second opinion from urologists. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS You may also complete an online appointment request form and we'll respond to schedule an appointment. 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. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. My strong preference would be to do FLA again and monitor. My long-term prognosis appears to be good with minimal side effects. -------------------------------------------------------- The side effects of the cut, radiate, hormone regime are unacceptable to me. 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. Asking about other experience with conflicting Prostate Biopsy Opinions. 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). Are you sure you want to block this member? A. Prostate, right base, core biopsy: Masks are required inside all of our care facilities. I certainly would - after all, there's a certain brotherhood bond here. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. 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. Using the Bullet Volume gives you gland of 25.55. 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. I am relatively new to this forum and trying to educate myself as to my best course of treatment. Prostate, right medial apex: Urology. 1. Radhakrishnan A, Grande D, Mitra N, Pollack CE. We are vaccinating all eligible patients. Conflicting Prostate Biopsy OpinionsWhat to Do? In fact, additional biopsies revealed no additional cancer. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. peripheral zone signal intensity on T2-weighted images. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. 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. Benign Processes: -------------------------------------------------------- Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. Do I need a third opinion? A newly published paper by Fischer et al. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Then about a month later I started 28 fractions of Proton Radiation.It was painless. In 2006 my PSA was .6. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. Receiving a second opinion was not associated with perceived quality of prostate cancer 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. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. Two weeks later I meet with my Johns Hopkins Dr. We will give that a shot and see how it turns out. Other Features: It is still important to do your own research. Y'all are in my prayers! 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. Include Your Primary Care Physician as Member of Your Treatment Team. He never sought treatment for the injury. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet.
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