lesion. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. 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. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 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. After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. Prostate, right medial apex: I opted to waive the biopsy, wait 1 year and test again. 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. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. 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. Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). Types of questions that pathologists often address in our second opinions: However, there were no other suspicious areas on MRI. Anyway, would appreciate knowing how to contact Johns Hopkins. Thanks, Why It's Worth Seeking a Second Opinion for Prostate Cancer Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. This teamwork ensures the best possible patient outcomes. It will be interesting to see, I think. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. I had my first of those 2 PSA tests last week and it dropped to 4.77. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Oncologist. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. Not all cancers are the same and not all treatment plans are absolutely clear. By Dec 2019, my PSA reached 4.13. 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. Prostate cancer is a slow growing condition. I was on active surveillance after a FLA procedure done in 2018. (PZ) - normal Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. I am 65 and in excellent general health. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. * Sloan only sent partial cores, slides 1 and 4. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it). Can it be salvaged or are the risks of cancer too high? Instead, I did my homework. Cancer. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. One of the problems with second opinions is that insurers may not cover the expense. Symptoms include leaking and discomfort. 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. Second Opinions in Prostate Cancer - American Council on Science and Health They are not objective. Thanks for considering. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. Need guidance choosing from multiple treatment options. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. Suspicion for malignancy left anterior base-to-apex transition zone; Had a little complication a day after release, excessive blood/clots in urine. SMIL radiologist reported nothing found. For cancers that are less common, second opinions can offer more treatment options. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. Benign Processes: Prostate, left lateral base: - High grade prostatic intraepithelial neoplasia (HGPIN) Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. 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. 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. doi: 10.1136/bmjopen-2020-044033. FLA DONE AT FIRST BIOPSY G- 7. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Ask your doctor for a copy of your complete medical record. This is why the prostate is important to the body. During puberty, the body produces semen in a large number of cases, including enlarged prostate. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. John Hopkins Prostate Cancer Second Opinion Surabhi Dangi-Garimella, PhD. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. I made the appointments. 1st opinion. Total Gleason score: 6 Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. Treatment must be chosen based on stage and your And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Grade Group: 2 HHS Vulnerability Disclosure, Help My strong preference would be to do FLA again and monitor. Explore our state-of-the-art patient care facilities in the Sheikh Zayed Tower. And if so, what does being accepted in a AS program look like, do I need to be present at their location? So, I asked the Radiologist if she will schedule one for me. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. :) Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. According to the doctor it is around 3 mm. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. Thankfully, prostate cancer is extremely slow growing. 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. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. Cancer 2017;123:1027-34. You may also complete an online appointment request form and we'll respond to schedule an appointment. It's really that simple! Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. I'm going to reach out to UCLA to see what they can do. Benign Processes: doi: 10.1002/cncr.30412. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. Benign prostatic tissue There are lots of lessons learned on the forum. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) Blessings. DRE is always normal. Now the oncologist wants to perform a PSMA Pet Scan. Medical record collection from doctors and hospitals. I really just want the results of their innovative PTEN test. Have been told a health condition is not treatable. Yet none of my doctors ever mentioned it! The total number of cores identified is 3 My experience at Johns Hopkins was awesome. asymmetric central zone tissue more pronounced on the left. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. An accurate diagnosis is essential to ensure the most effective treatment. Forty percent of the men obtained a second opinion from urologists, most often because they wanted more information about their cancer or wanted to be seen by the best doctor . Consultation with your nurse care manager. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? Benign fibromuscular stroma; no prostatic glands are identified Sought Johns Hopkins second opinion of pathology slides. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. * PIRADS v2 Score: 5 Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. I have developed an "abscess" on my prostate. 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. 3: Prostate, right medial apex 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. 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. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. Masks are required inside all of our care facilities. A new study by researchers at the Johns Hopkins University has found that . __________________________________________________________________________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. Get a Second Opinion Therefore, the value of these second opinions remains unknown. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. FAX 310-574-4002 P60 MD006900/MD/NIMHD NIH HHS/United States, T32 HL007180/HL/NHLBI NIH HHS/United States, K07 CA151910/CA/NCI NIH HHS/United States, P30 CA016520/CA/NCI NIH HHS/United States, K07 CA163616/CA/NCI NIH HHS/United States. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. This shows very high signal intensity on the diffusion-weighted -------------------------------------------------------- - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Given that some 3+4 is now evident, I can no longer say that all my PCa is all 3+3 and that I can stay on AS for an extended period. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. Assessment categories for this lesion: By basing a treatment You think another treatment might be available. * Seminal vesicle invasion: None. If anyone has used him, please let me know what your experience was like. 1. Are considering a treatment that involves significant risks, such as surgery. It would be more convenient to use Mayo but I want the best practitioner regardless. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. 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. So my question for you is have you ever heard of PRECISE and if so what should I make of it? Prostatic Adenocarcinoma However, there are also many more options for treatment and these options are more complicated than in the past. This urologist can get you in for surgery next week. Some pathologists have more experience than others. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. An official website of the United States government. 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. Best practices dictate that you obtain a second confirmatory pathology evaluation. 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. It took me awhile but minutes ago received my second opinion from Johns Hopkins. This is often the case when the primary physician advises an expensive treatment. very activerun/cycle 6 days a week We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. 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. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has 180 days after treatment PSA was .50. - DWI-ADC = 4/5 By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. It is OK to be overwhelmed with info. And just this week, 1 YEAR post treatment, it is .46. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. The majority had lower risk tumors and clinical staging of 1 40% sought second opinions with about half having more than one reason Men seeking second opinions tended to be younger and better educated citing the need for more information as their reason. Question anemia. Had my PSA remained static I'd have remained on AS and had I grown a Target Lesion I'd have sought focal treatment.This science is emerging and only getting better. * Membranous urethral length: 1.2 cm Adenocarcinoma: Dr. Nour is 100% sure that nothing has spread. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. Are you sure you want to block this member? 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. Surgery took about 3 hrs. You Luckily, his report co-coincided with the original QDx report. 2. You're more likely to develop prostate cancers that are more likely to spread. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. A second opinion can accomplish a number of things. 4. No definitive evidence of distant metastatic disease is seen." This condition causes pain in the lower back and groin area, and may cause urinary retention. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. It hasn't let me down. In the mean time my PSA was movingno longer static, but never back up to 6. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of ---------------------------------------------------- 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. In some situations, insurers will even insist on a second opinion. Just got my pathology results. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms. Masks are required inside all of our care facilities. According to The National Institute on Aging, prostate problems are common after age 50. And should I treat prostatitis before FLA? 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. Be sure to confirm your diagnosis at a center of excellence. Is it done through my doctor or do I do it myself with sending CDs of the MRI? 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. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. Prostate Cancer | Johns Hopkins Medicine All rights reserved. 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. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. Prostate Cancer News, Reviews & Views: Second opinions Your email address will not be published. 5. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. Do I need a third opinion? focal peripheral zone lesions. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. Dont Miss: Screening For Prostate Cancer Icd 10. 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. Not all cancers are the same and not all treatment plans are absolutely clear. Prostate cancer is an 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. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. - 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 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. Have you heard of PRECISE follow up score for an MRI? Patients may experience a fever or chills as a result of the infection. Since I have gotten so much out of this forum, I thought Id provide my story to help others. -------------------------------------------------------- I'm turning 58 in one week. You can call and speak with his assistant at: (410) 614-6330. Prostate, right medial base: For these reasons, it is a good idea for HMO members to get a second opinion and make sure they are informed about clinical trials or other promising new treatments. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. 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. Interesting differences: Ask us questions on this webpage. PDF Cancer A Second Opinion A Look At Understanding Controlling And Curing I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. 3. Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. 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). And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Here are seven tips for seeking second opinions for prostate cancer: 1. I've been on AS since April 2016. I would appreciate hearing from that 2.8% out there who have an intraductal component.

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