Get directions, important phone numbers, locations and more. 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. Adenocarcinoma: It will be interesting to see, I think. It hasn't let me down. 5: Prostate, left medial apex There is hope. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. You May Like: Prostate Cancer External Beam Radiation Side Effects. 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. 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. - High grade prostatic intraepithelial neoplasia (HGPIN) of tumor in the rectal prostatic angles. The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. Prostate, left medial base: The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Surgery took about 3 hrs. Would you like email updates of new search results? In the United States, prostate cancer is among the most common cancers found in men. decision on a single medical opinion or the first appointment you get, you may I would really love to hear from you. According to the doctor it is around 3 mm. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. 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. -------------------------------------------------------- The side effects of the cut, radiate, hormone regime are unacceptable to me. Treatment must be chosen based on stage and your 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. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. This is a PI-RADS 5 lesion in Good Day Everyone. My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. 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. 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. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. Your doctor is not a specialist in your type of . 1. What are you doing about it? Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. 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. I talked with Dr. Epstein who expressed Johns Hopkins' conservative views to not underestimate GS 6 and to consider surgery and/or radiation that have been used successfully for many years in saving lives. They won't be offended, and they may even be able to recommend a specialist for you to see. I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. This is not true. Benign Processes: If I am rested, I find that I am more ready than if I am not. Greetings gentlemen! 7 Tips for Seeking Second Opinions For Men with Prostate Cancer My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. Further, the two tumors in question have not really changed much in size for more than 2 years. 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. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. Not all cancers are the same and not all treatment plans are absolutely clear. 3T MRI with coil is done initially, along with a TRUS biopsy. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. Assessment categories for this lesion: You have a rare or unusual cancer. 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. Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm Either the patient or the primary physician can initiate the process of getting a second opinion. 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 . FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. 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. Brief MRI history. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. Masks are required inside all of our care facilities. 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. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. 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. I am doing one in 6 weeks, regardless. Expert review of your case by a Cleveland Clinic specialist. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. Dr. Nour - Emory in Atlanta. The percentage of Gleason grade 4 and/or 5 is 5 % Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. Benign Processes: 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. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. Question anemia. I had a follow up 3T MRI guided biopsy on March 18 at Emory. And if so, what does being accepted in a AS program look like, do I need to be present at their location? Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. LESION 1 BJU Int. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. If these do not work, your symptoms could progress and become chronic. A new study by researchers at the Johns Hopkins University has found that . -------------------------------------------------------- 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. I would appreciate hearing from that 2.8% out there who have an intraductal component. Five years ago I had a TURP. I worked out every day. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Nov 7, 2016. You receive a secure, private online consultation without leaving home. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. My plan is to choose quality of treatment over cost of the treatment. Total Gleason score: 7 I have selected Focal Laser Ablation as my future (soon) treatment. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. Since I have gotten so much out of this forum, I thought Id provide my story to help others. I wish the VA would be more informative about this disease they owe it to our veterans. We are vaccinating all eligible patients. Johns Hopkins second opinion - nothing found. undefined will no longer be visible to you including posts, replies, and photos. I guess TWO national centers of excellence are better than one? Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers After applying exclusion criteria, the final analytic cohort included 2365 respondents. 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. Seminal vesicles and other margins are negative for tumor. poorly defined margins and intermediate to low T2. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) 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. Bladder: Normal. But in the spirit of disclosure for those of you with BPH a TURP can complicate a future Radical Prostatectomy (or possibly Cryo) and increase the risk of side effect risks. Prostatic Adenocarcinoma Got my physical and normal DRE with new Dr. No issues identified. 2. A. Prostate, right base, core biopsy: 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. Breast Cancer: When to Get a Second Opinion - WebMD Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Oncologist. The total number of cores identified is 3 I recently sent my Pathology Slides to Dr. Epstein for a Second Review. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Have been diagnosed with a serious or rare health condition. The biopsy took 12 cores, two from each lesion area and 8 randomly. Also Check: Prostate Cancer Stage 7 Treatment. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Here are the details: 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). PI-RADS v2 score: 5. Background: Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: Two weeks later I meet with my Johns Hopkins Dr. 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. -------------------------------------------------------- Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). 3. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. They find that one of my 5-10% Gleason 6 core is actually a 50% Gleason 7(3+4) and the MRI was so cloudy with blood from original biopsy they said they couldnt determine much. 30%/40% or higher)? My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. 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. Doctors can review their peers treatment suggestions and explain why they agree or disagree. Prostate, left medial apex: When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. Why It's Worth Seeking a Second Opinion for Prostate Cancer Now, I would like to send Radiology for a similar review. government site. One of the problems with second opinions is that insurers may not cover the expense. Details are here: * Asked and Dr. said he isn't overly concerned about perineural finding with the grade and it won't impact treatment options or overall prognosis. An accurate diagnosis is essential to ensure the most effective treatment. No extraprostatic extension. As a result, patients struggle to differentiate bias from fact. By Dec 2019, my PSA reached 4.13. - PI-RADS for this lesion = 4/5 It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. My mind goes all over the place as to why this is. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. Check Biopsy and Imaging Results for Accuracy. This is often the case when the primary physician advises an expensive treatment. Getting A Second Opinion On Your Pathology Report - Cancer ABCs Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com Our team approach brings together highly experienced prostate cancer experts from across disciplines to collaborate on each patients total care, from diagnosis through treatment and recovery. Do I need a third opinion? Thanks to all of you for sharing! Ask us questions on this webpage. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. About this time, I started reading this forum and my ignorance starts going away. 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. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). 7. I was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. If these do not work, your symptoms could progress and become chronic. 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 was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. I hope my story helps anyone out there just starting the process. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. * Gleason Score: 3+3 (2 of 6 specimens) Want confirmation about a diagnosis or treatment. The biopsy took 3 samples from the targeted region plus 16 sextant. 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. 2016 American Cancer Society. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Seminal vesicles are normal. 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. BONES: No suspicious osseous 6. Asking about other experience with conflicting Prostate Biopsy Opinions. The average age at the time of prostate cancer diagnosis is about 66. I also had my PTEN test by META-MARK ( I don't have much to say about how I was treated by MM, but I won't be using their services again). 4. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. Include Your Primary Care Physician as Member of Your Treatment Team. (I must say that those low numbers concern me a bit.) lesion. Everything seems to be on track to remove the cancer and be cured! My strong preference would be to do FLA again and monitor. Therefore, the value of these second opinions remains unknown. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. - 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 Surprisingly, while one in nine men will get diagnosed with prostate cancer in their lifetime1, there are very few doctors who specialize exclusively in treating prostate cancer. Read Also: What Are The Signs Of Prostate Infection. Prostate, right lateral apex: I retested in January 2019 and scored 4.20. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. Clipboard, Search History, and several other advanced features are temporarily unavailable. They agreed with the PI-RADS 4. 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. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Second round of Radiation Therapy - t - Advanced Prostate 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." F. Prostate, left apex, core biopsy: The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Hello. Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. PSA had increased to 5.4. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. I requested a second opinion from Johns Hopkins and they found 1 lesion was 3+3=6 and the second lesion was 3+4 =7, with less than 5% pattern 4. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. JAMA Netw Open. )As for side effectsI occasionally have some urgency/hesitancy having to pee. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. My new Dr however didnt order PSA so I asked him for one. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) I didn't study for the test and it's possible some morning activities might have affected my test score :) He also stated that he would ONLY recommend FLA if done within a trial. Does every biopsy provide a Gleason Score? Benign prostatic tissue At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. MEASUREMENTS: 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Comments appreciated, I was confident I was making the right decision. For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. Read books and realize as soon as they are published, they are outdated. Am I missing anything? Please enable it to take advantage of the complete set of features! Benign fibromuscular stroma; no prostatic glands are identified 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. 2. Best wishes to all those whose concerns for the day are far more serious than mine. It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! So fingers crossed. My first PSA was 8.03. Second opinions offer different things in different circumstances, Dr. Matasar says. A second opinion can accomplish a number of things. I just turned 71 in February. I have actually had a second opinion a while back from Dr. Bush. * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project My involvement is below maximum of 15% of core. This championship swimmer sought a second opinion at Johns Hopkins. 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. * Location: Right, anterior, apex, peripheral zone An accurate diagnosis is essential to ensure the most effective treatment. No extraprostatic extension. Know Your Stage. 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. 3. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. Prostate dimensions: 4.1 x 2.8 x 3.4 cm And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. My other option for treatment is either LDR or HDR brachytherapy. Now the oncologist wants to perform a PSMA Pet Scan. Then about a month later I started 28 fractions of Proton Radiation.It was painless. PSA that brought me to this was 7.1. Contact us or find a patient care location. 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. Dont Miss: Bladder Control After Prostate Surgery. Metastatic disease considered less likely for this pattern. Required fields are marked *, PHONE 310-827-7707 asymmetric central zone tissue more pronounced on the left. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. Experts believe that this study is the first in history to have achieved such results. 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. 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. A newly published paper by Fischer et al. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Are considering a treatment that involves significant risks, such as surgery. probably organ confined disease. NONE of the many radiation oncologists, surgeons or urologists I've spoken with in my journey have ever mentioned the term to me so I had to look it up. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Get a Second Opinion: Johns Hopkins Kimmel Cancer Center