I could not get a definitive answer from them on how much, how many cells, or any information. 6. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Johns Hopkins is home to many of the world's leaders in Pathology. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. We will give that a shot and see how it turns out. Grade Group: 2 And if so, what does being accepted in a AS program look like, do I need to be present at their location? Also, their protocol would be another biopsy, but he was comfortable with the image and velocity of PSA that he didn't have to have one to start treatmentand I was pretty hesitant (given the image and PSA) to take ADT, and didn't see a biopsy changing my mind regarding treatment and/or ADT.Oh. About this time, I started reading this forum and my ignorance starts going away. Everything seems to be on track to remove the cancer and be cured! 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. * Extracapsular extension: Possible involvement of the anterior Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. There is hope. This urologist can get you in for surgery next week. 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 am unfortunately "officially" joining the club after getting my biopsy results today. DIAGNOSIS: But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). In other words, the cancer is still contained within the prostate. 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). Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. Many thanks for that. Here are seven tips for seeking second opinions for prostate cancer: 1. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. Surabhi Dangi-Garimella, PhD. 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. Thanks, BigD. Prostate Cancer Grading: * Prostate volume: 22 cc AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Assessment categories for this lesion: When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. Low volume post-void residual urine is present in the bladder. This site needs JavaScript to work properly. Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. JAMA Netw Open. He never sought treatment for the injury. 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. Second opinion on biopsy slides - malecare.org But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Benign Processes: :) Does this also include HIFU, Cryoablation? 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. Depending on your location, you may be able to have a telemedicine consultation. 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. curing cancer, prostate cancer questions johns hopkins hospital, josef issels wikipedia, cancer a second opinion a look at book by josef issels, coping with metastatic cancer cancer net, pdf americans health priorities curing cancer and, what is immunotherapy cancer research institute cri, cancer a second opinion a . 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). Just took time off and then life happened.Thanks in advance for the insights. Second Opinions in Prostate Cancer - American Council on Science and Health The results were ambiguous. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. My strong preference would be to do FLA again and monitor. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. And again, most of you tell me time is on my side, so I am comforted in hearing that. 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. This is not true. You may choose to consider a second opinion if you: 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. Other labs for second . Prostate, left anterior MRI lesion: Masks are required inside all of our care facilities. Does every biopsy provide a Gleason Score? information. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Further, the two tumors in question have not really changed much in size for more than 2 years. All rights reserved. I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find. Secondary Gleason grade: 4 I am 65 and in excellent general health. A enlarged prostate can also cause blockages in the urethra. Slightly FOIA And should I treat prostatitis before FLA? 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? images and markedly reduced ADC. 1st opinion"Note is made of sclerotic changes in the right pubic bone adjacent to the symphysis pubis having only low-level activity and this is thought to be more likely due to degenerative changes rather than bony metastasis." 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. It was easy. But I've had trouble getting Dr. Chang's office to provide any patient referrals. not hear all the viable treatment options or receive the most up to date Im immediately referred to Urologist. Anyone with insight into this and advice? 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. The https:// ensures that you are connecting to the When I was diagnosed I really thought that I will live only 2 years. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into 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. Using the Bullet Volume gives you gland of 25.55. So, Radiation Oncologist prescribed Cialis 5mg, daily. The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. It is OK to be scared. We have a consult on Friday with the 1st opinion doc to review all tests. - PI-RADS for this lesion = 4/5 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. PI-RADS v2 score: 5. Video consultation and written report from your expert. 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. Two from one lesion were positive as was one of the two from the other. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. You May Like: Prostate Cancer External Beam Radiation Side Effects. Adenocarcinoma: Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. One to a 3+4=7 and the other to a 3+3=6. I can do radiation as a monotherapy. You May Like: Sbrt Radiation Therapy Prostate Cancer. Expert review of your case by a Cleveland Clinic specialist. -------------------------------------------------------- 5. I worked out every day and it wasn't until the last week did I feel a bit fatiguedand experience a bit of urgency and hesitation having to peeflowmax fixed that right up!90 days after treatment my PSA came in at .56. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) MY THOUGHTS AND ANYTHING DOCTOR NOTED: 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. 4. Background: Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. 3. It is OK to be overwhelmed with info. There are also many reasons why you may want to seek another opinion during the course of your cancer care. Prostate, right lateral base: Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists. Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com My urologist suggested a couple more PSA tests followed by an MRI. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Second opinions not likely to change prostate cancer treatment Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. 10. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. Out of 12 cores, 9 are positive. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. And it is OK to have paralysis by over-analysis. I worked out every day. Consultation with your nurse care manager. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. You can call and speak with his assistant at: (410) 614-6330. 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. EDI am now 52 and not quite functioning like I did 4+ years ago. 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. So now things are getting exciting. And just this week, 1 YEAR post treatment, it is .46. 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. Ask us questions on this webpage. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. Get a Second Opinion What can a second opinion tell me? An accurate diagnosis is essential to ensure the most effective treatment. 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. Get a Second Opinion | Johns Hopkins Pathology 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. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). The people were great. PELVIC LYMPH NODES: No adenopathy. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . 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. 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. Grade Group: 1 Now the oncologist wants to perform a PSMA Pet Scan. Prostate, left medial apex: 7: Prostate, left lateral apex Those readings were reported on a second opinion by Dr. Epstein. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Confirm biopsy and imaging results with centers of excellence before making any final decisions. Prostate, left medial base: Enter the last name, specialty or keyword for your search below. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. 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. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. This has raised some questions on all the scans so far. EDI am now 52 and not quite functioning like I did 4+ years ago. Especially opinions other than those of the first Urologist you see. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. transition zone. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. Good Morning Brothers- Cancer patients are encouraged to obtain second opinions before starting treatment. In some situations, insurers will even insist on a second opinion. Instructions for Second Opinion on Pathology (Gleason score) I wish the VA would be more informative about this disease they owe it to our veterans. "We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer," said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in . OTHER: None. Wow, I sound like a snob now! Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. With that alone, I would likely be a candidate for continued Active Surveillance. During puberty, the body produces semen in a large number of cases, including enlarged prostate. C. Prostate, right apex, core biopsy: 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". 30%/40% or higher)? Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? It got discussions started and questions answered. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. 2. This championship swimmer sought a second opinion at Johns Hopkins. Overall my PSA is between 4 and 10. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. We are vaccinating all eligible patients. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. More medical freakouts. An acute bacterial infection can cause a burning sensation. It is OK to be scared. Yet none of my doctors ever mentioned it! Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. Symptoms include leaking and discomfort. I guess TWO national centers of excellence are better than one? Prostatic Adenocarcinoma Prostate, left lateral apex: It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. 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. At the Johns Hopkins Medical Institutions, he is Professor of Pathology, Urology, and Oncology the recipient of the Reinhard Chair of Urological Pathology and Director of Surgical Pathology. Some men have minimal or no symptoms at all. Before No extraprostatic extension. You're more likely to develop prostate cancers that are more likely to spread. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. And it is OK to have paralysis by over-analysis. Second opinions offer different things in different circumstances, Dr. Matasar says. Here are the details: Some men may have an enlarged prostate but not notice it. 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. When people recommend going to a Center of Excellence, believe them. Want confirmation about a diagnosis or treatment. Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. You're also at greater risk of prostate cancer forming before age 50. A. Prostate, right base, core biopsy: Other Features: Should You Exercise When Youre Expecting? have no symptoms, and yet you have cancer? 2020 Dec 1;3(12):e2028320. Good pathology readings require experience and a high level of expertise. Urology. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons.

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