By basing a treatment Family history of prostate cancer. 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. 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? (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. I had a follow up 3T MRI guided biopsy on March 18 at Emory. Prostate cancer is a slow growing condition. Not all cancers are the same and not all treatment plans are absolutely clear. Bring All Labs/Notes to Each Appointment. Some men may have an enlarged prostate but not notice it. * Extracapsular extension: Possible involvement of the anterior 2. 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. They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. 2. I really just want the results of their innovative PTEN test. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Read books and realize as soon as they are published, they are outdated. Good Luck and God Bless everyone. And if so, what does being accepted in a AS program look like, do I need to be present at their location? I suggest for all that hear, "you have cancer" that you seek more opinions! 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 will say, the people I dealt with at Johns Hopkins were extremely nice and professional. 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. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Seems like a simple request. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! It hasn't let me down. Second opinions offer different things in different circumstances, Dr. Matasar says. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. Those readings were reported on a second opinion by Dr. Epstein. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. I'm leaning towards SBRT. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. 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 have searched the country for intervential radiologist that perform FLA on the prostate. My prior Prolaris study (2018) before the FLA was very low risk. 5. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. 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. Extracapsular extension: The prostatic capsule is preserved. I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. 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. I'm going to reach out to UCLA to see what they can do. Cancer 2017;123:1027-34. There are lots of lessons learned on the forum. F. Prostate, left apex, core biopsy: I've been on AS since April 2016. 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. It will be interesting to see, I think. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." 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. There are also some cases of the test showing no depletion but being wrong. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. I was confident I was making the right decision. Also these lesions did not abut or touch the wall of the prostate. Some specialists have more expertise and more experience than others. Your doctor is not sure what is wrong with you. 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. Dr. Jonathan Epstein of Johns Hopkins University Hospital. I still have some urgency and frequency issues, but I am not complaining too bad. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Hoping that after I go through this that my advice to others will be able to guide them and that they can learn from my experience, as I feel I am gaining a solid foundation from both a practical and mental standpoint. Patient-Driven Second Opinions in Oncology: A Systematic Review. 30%/40% or higher)? 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. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. I am already positively surprised that I am still alive 4.5 years after my diagnosis. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. -------------------------------------------------------- Getting a second opinion from us is easy, convenient, and all done remotely. Youve just been diagnosed with prostate cancer. THANKS! Johns Hopkins Prostate Cancer Second Opinion official website and that any information you provide is encrypted It hasn't let me down. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. I applaud Dr Scholz for his dedication and explanation of such a complex cancer, that has not had his common sense help available for men with prostate cancer. If these do not work, your symptoms could progress and become chronic. The results of Oncotype came back and it was a bad report. radiation, active surveillance, surgery, hormone therapy, and more. Finally, things are set and I know what is going to happen. In severe cases, a catheter may be required to relieve the symptoms. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm This teamwork ensures the best possible patient outcomes. Call us with any questions: 410-955-2405, ext. Expert review of your case by a Cleveland Clinic specialist. doi: 10.1136/bmjopen-2020-044033. The percentage of tissue with carcinoma is 70% My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. Immediate means 6 weeks just to see his NP. 1. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? 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 took me awhile but minutes ago received my second opinion from Johns Hopkins. EDI am now 52 and not quite functioning like I did 4+ years ago. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. E. Prostate, left mid, core biopsy: I recently sent my Pathology Slides to Dr. Epstein for a Second Review. Second opinions not likely to change prostate cancer treatment Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? They basically said it didn't matter. feel the clock ticking. Allow yourself the time to seek multiple opinions. The biopsy took 12 cores, two from each lesion area and 8 randomly. 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. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. 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. You Seeking a Second Opinion - American Cancer Society Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. The .gov means its official. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. Hillen MA, Medendorp NM, Daams JG, Smets EMA. Reinterpretation of imaging scans and lab tests. * Location: Left, anterior, base to apex, transition zone - Benign prostatic tissue The site is secure. * Sloan only sent partial cores, slides 1 and 4. Reinterpretation of imaging scans and lab tests. Masks are required inside all of our care facilities. Thanks for considering. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. 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. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. A week later had catheter removed and had no bladder leakage problems. Pathology Second Opinion-J.Epstein,M.D. Pathologist-Johns Hopkins In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. 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. SO. Bethesda, MD 20894, Web Policies Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. So, Radiation Oncologist prescribed Cialis 5mg, daily. I certainly would - after all, there's a certain brotherhood bond here. The neurovascular bundles are intact. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). * PIRADS v2 Score: 3 I was offered to have my first biopsy sent to Johns Hopkins for second opinion and said why not? which came back with Gleason 9 three weeks after having the what we thought was G-7 ablated. 4. I have actually had a second opinion a while back from Dr. Bush. BASE DATA: You think your doctor is underestimating how serious your cancer is. The side effects of the cut, radiate, hormone regime are unacceptable to me. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Intensity: min 148 / Max 459 I met with the radiologist 3/17 and he leans toward an IMRT radiation regimen of 5 or 20 sessions TBD combined with ADT (6-month shot but maybe 4 months was enough). How could this compare using only partial slide re-reading? Asking about other experience with conflicting Prostate Biopsy Opinions. They are not objective. There is no extraprostatic extension. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. notable articles of 2016 - Johns Hopkins Bloomberg School of Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Also Check: How Old Can You Be To Get Prostate Cancer. Total Gleason score: 7 * PIRADS v2 Score: 5 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. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Based on this forum, Im very lucky for this outcome. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. Second opinion Johns Hopkins? - Prostate cancer * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) In 2006 my PSA was .6. 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.). A biopsy was performed on 2/26. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Nov 7, 2016. Know Your Stage. Johns Hopkins is home to many of the world's leaders in Pathology. Low volume post-void residual urine is present in the bladder. 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. A PSA test at time of biopsy revealed my PSA had risen to 6.5. A second opinion is part of the education process that is critical for many cancer patients. Possible additional organ confined malignant lesion in right apex Some men may have an enlarged prostate but not notice it. So now things are getting exciting. More medical freakouts. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? Overall my PSA is between 4 and 10. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. Us Too Prostate is a great club and many of you have helped me a lot already. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. 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. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. From what I've learned from Dr. Scholz videos at PCRI, and from posts on this site it would lead me to believe the DX test is fairly common knowledge. Expert review of your case by a Cleveland Clinic specialist. have no symptoms, and yet you have cancer? MEASUREMENTS: PREVIOUS MRI RESULTS (LOTS of them) * Prostate size: 3.9 x 2.8 x 3. cm B. Prostate, right mid, core biopsy: (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. PELVIC LYMPH NODES: No adenopathy. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. The percentage of tissue with carcinoma is 45% In other words, the cancer is still contained within the prostate. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. Symptoms include leaking and discomfort. Hi All, What are your opinions of what that is, and where to get it? There is no one-size-fits-all treatment for prostate cancer. * 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. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. We are vaccinating all eligible patients. John, I was diagnosed on 11 December, 2013. Benign prostatic tissue A doctor may prescribe surgery or perform an endoscopic procedure. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Benign fibromuscular stroma; no prostatic glands are identified Surabhi Dangi-Garimella, PhD. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. focal peripheral zone lesions. 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. Blessings. It can be caused by many factors, including infection and inflammation. :) This is not true. 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.