Anyone else encounter something like this? The primary goal is to be cured with the least toxic, most effective approach. DIAGNOSIS: Thanks, 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. Men need to be educated on all treatment options to protect themselves from a biased industry. 8. Lesion 1: Left mid-base transition zone. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. The peripheral zone has a patchy signal pattern. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. FOIA 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. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. Details are here: T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. 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. So the pathologist suggested a second opinion. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. This condition causes pain in the lower back and groin area, and may cause urinary retention. A PSA test at time of biopsy revealed my PSA had risen to 6.5. 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. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. It took me awhile but minutes ago received my second opinion from Johns Hopkins. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). To schedule an in-person visit for a second opinion or to determine if a telemedicine consultation is possible, call: In addition to cancer, our urologic team provides second opinions regarding urinary stone disease, urinary tract reconstruction, incontinence, male infertility and sexual health, and many other urologic conditions or procedures. As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. Rectal cancer.A small trial that saw 18 rectal cancer patients taking the same drug, dostarlimab, appears to have produced an astonishing result: The cancer vanished in every single participant. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. Cancer patients are encouraged to obtain second opinions before starting treatment. Thank you for your participation! 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. I was on disability from work the entire time (not that I was disabled, but as a pilot, I couldn't very well work and get treatment at the same time. The side effects of the cut, radiate, hormone regime are unacceptable to me. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. 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. 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. 5. * Location: Right, anterior, apex, peripheral zone Notice of Privacy Practices(Patients & Health Plan Members). E. Prostate, left mid, core biopsy: The prostates function is to create some of the fluid that insulates sperm cells found in semen. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. So, I also sent this MRI result to Johns Hopkins for a second opinion. I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). That is literally the first time I heard that term other than seeing it in my pathology report. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. Spent the night in hospital with very little pain after the first couple of hrs. 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. An increase of 1.1 in 3 months is not good news. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Same with the amount of how much pattern 4. Hello everyone. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? Prostate cancer is the second-most diagnosed cancer in American men. 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). Accessibility If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. The study was published online Nov. 7 in the journal Cancer. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. 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. When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. Your doctor is not sure what is wrong with you. Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. You May Like: Prostate Radiation Treatment Side Effects. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . See this image and copyright information in PMC. He also stated that he would ONLY recommend FLA if done within a trial. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. 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. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. Seems like a simple request. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. Other Features: 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. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) His second opinion just came back. Thanks for considering. Prostate Cancer Grading: 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. Also, infection was noted, so the current PSA is high in part due to prostatitis. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. 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. 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. feel the clock ticking. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. 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. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. Following the advice of all on here, I need a team of doctors to manage my care. 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. Every year I got a PSA and DRE during my annual physical. So now things are getting exciting. 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. (PZ) - normal Perineural invasion is identified A doctor may prescribe surgery or perform an endoscopic procedure. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. I've had what I would consider a fluctuating PSA since first tested in November 2018. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. There are also some cases of the test showing no depletion but being wrong. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Johns Hopkins is home to many of the world's leaders in Pathology. -------------------------------------------------------- the transition zone. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Obviously the Covid 19 issue is playing a part in all of our decisions. Here are the details: Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. A blocked urethra can also damage the kidneys. An acute bacterial infection can cause a burning sensation. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Consultation with your nurse care manager. 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 . HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. They won't be offended, and they may even be able to recommend a specialist for you to see. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. Instead, I did my homework. Video consultation and written report from your expert. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. He also said perinueral invasion, but not extracapsular extension. I am 62 years old. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. Read books and realize as soon as they are published, they are outdated. Clipboard, Search History, and several other advanced features are temporarily unavailable. I really just want the results of their innovative PTEN test. Other: There is trace ascites in the mesosigmoid. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. 7. 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." At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. That being said, they can be a beneficial member of the treatment team. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. PROSTATE LESIONS: So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers LESION 2 Required fields are marked *, PHONE 310-827-7707 Dr. Nour - Emory in Atlanta. Other labs for second . - 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 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. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results. I am relatively new to this forum and trying to educate myself as to my best course of treatment. It was easy. * PIRADS v2 Score: 3 John. This is a PI-RADS 5 lesion in Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. By basing a treatment However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. Find more COVID-19 testing locations on Maryland.gov. Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? It can be caused by many factors, including infection and inflammation. 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. I was diagnosed with a 3T MP MRI and a 3T MP MRI guided 4 core biopsy. Now, I would like to send Radiology for a similar review. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night.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. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS 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 symptoms of acute bacterial prostatitis are similar to those of CPPS. 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. Pathology reports are subjective. We will give that a shot and see how it turns out. Primary Gleason grade: 3 We are vaccinating all eligible patients. Prostate, right anterior MRI lesion: 7: Prostate, left lateral apex My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (medial core: 3.5 mm, 30%; lateral core: 2.5 mm, 20%), 0.5 mm to the blue inked tissue edge (the closer) Does every biopsy provide a Gleason Score? In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). Bladder: Normal. I guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? Prostate Cancer Grading: Receiving a second opinion was not associated with perceived quality of prostate cancer care. 4. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. PSA had increased to 5.4. We have a consult on Friday with the 1st opinion doc to review all tests. Prostate, right lateral base: -------------------------------------------------------- With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. 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. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. It's a bit confusing since most experts now don't consider Gleason 6 to be a true cancer, so did i test positive in 2 cores or 4? radiation, active surveillance, surgery, hormone therapy, and more. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. Anything I am overlooking or need to add to my list of considerations? That's the good news. However, learning more about prostate cancer and prostate-related health issues can help optimize health. Reasons for obtaining a second opinion from urologists. Benign Processes: Greatest dimension 2cm. Many thanks for that. Prostate volume: 17.58 cc 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). Prostate, right lateral apex: 2021 Sep 24;11(9):e044033. Second opinions offer different things in different circumstances, Dr. Matasar says. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. 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. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. He also said I would tolerate any option well based on my age and health. 3/3 4K score 19% (high end of intermediate) Prostate, right medial apex: Just took time off and then life happened.Thanks in advance for the insights. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? 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. National Library of Medicine 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. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. Read books and realize as soon as they are published, they are outdated. Y'all are in my prayers! Extraprostatic extension: negative Oncologist. The neurovascular bundles are intact. So my question for you is have you ever heard of PRECISE and if so what should I make of it? Cancer 2017;123:1027-34. What are your opinions of what that is, and where to get it? I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. Also these lesions did not abut or touch the wall of the prostate. Epub 2010 Oct 20. Many researchers believe PTEN present is a strong brake on Some men have minimal or no symptoms at all. advising or treating it. 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. I've tried to find out about Dr. Wong but there's very little info on him. There are also many reasons why you may want to seek another opinion during the course of your cancer care. 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. I am 65 and in excellent general health. Especially opinions other than those of the first Urologist you see. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. Second opinion Biopsy came after FLA G-9. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. peripheral zone signal intensity on T2-weighted images. I wanted to keep my options open. 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. It was easy. There is hope. The https:// ensures that you are connecting to the Confirm biopsy and imaging results with centers of excellence before making any final decisions. However, there were no other suspicious areas on MRI. He has had a nagging "groin injury" for may years (he played pick up basket ball until he got injured) and we are now wondering if this could be the source of that recurring ache. 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.

Texas Syndicate Tattoos, Carnival Mardi Gras Itinerary 2022, Watkins Wellness Salt System Cartridge, St Edwards Funeral Home Obituaries, Articles J