No extraprostatic extension. We are vaccinating all eligible patients. Types of questions that pathologists often address in our second opinions: Benign prostatic tissue Secondary Gleason grade: 3 Suspicion for malignancy left anterior base-to-apex transition zone; You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. 6. At this time, I am leaning towards Active Surveillance or FLA. AS would be my choice, except that a total of three lesions, on both sides of Peripheral Zone, makes this controversial. The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. -------------------------------------------------------- I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. This shows very high signal intensity on the diffusion-weighted We are vaccinating all eligible patients. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). The symptoms of acute bacterial prostatitis are similar to those of CPPS. They did 9 patients in Phase I and there have been 12 so far in Phase II. If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices. Thanks! My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. 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. He was right. It has been 2.5 years and the PSA has still not doubled as well. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. 7 in 10 PATIENTS WHO GET A SECOND OPINION AT CTCA CHOOSE TO TREAT WITH US Call now to find out why: 800.888.8888 Rosie P. Colorectal Cancer 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. Lesion 2: Right mid anterior transition zone. Abstract Context: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. Prostate volume: 17.58 cc Watch: Are supplements good for prostate health? 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. (PZ) - normal A doctor may prescribe surgery or perform an endoscopic procedure. Dr. Dan Sperling - New York. Im immediately referred to Urologist. I'd like to talk with former patients who have gone through the procedure. PREVIOUS MRI RESULTS (LOTS of them) A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Also, a second opinion provides the opportunity to get information from someone other than the physician who will be directing treatment, which is usually the main source of information for most patients. Anyone else encounter something like this? 180 days after treatment PSA was .50. 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? Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. Brachytherapy Experience with Dr. Albert Chang at UCLA? 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 . of tumor in the rectal prostatic angles. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 1st opinion. Benign Processes: There are lots of lessons learned on the forum. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. Tumor Quantifications: Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Benign Processes: 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. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Luckily, his report co-coincided with the original QDx report. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. However, there are also many more options for treatment and these options are more complicated than in the past. Be well. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Seems like a simple request. 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. 9. I had a follow up 3T MRI guided biopsy on March 18 at Emory. doi: 10.1002/cncr.30412. The average age at the time of prostate cancer diagnosis is about 66. PROSTATE LESIONS: Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. EDI am now 52 and not quite functioning like I did 4+ years ago. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. IMPRESSION: Symptoms include leaking and discomfort. * Extracapsular extension: Possible involvement of the anterior 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). After a little experimenting I have been able to achieve a partial erection. Even if I go the radiation route, should I try for Proton radiation or some other type? Hi All, 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. In the mean time my PSA was movingno longer static, but never back up to 6. Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) HHS Vulnerability Disclosure, Help 1. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. Prostate Cancer Grading: The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. This is often the case when the primary physician advises an expensive treatment. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. 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. OTHER: None. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. I am relatively new to this forum and trying to educate myself as to my best course of treatment. 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 assume it is not free. 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. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. 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. I'm trying to figure out why the PSA keeps rising. Now its easier than ever to get the answers you need and peace of mind you deserve. Please enable it to take advantage of the complete set of features! Good Day Everyone. 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. Using the Bullet Volume gives you gland of 25.55. Move ahead to Dec 2020. Benign prostatic tissue -------------------------------------------------------- Patients may experience a fever or chills as a result of the infection. 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. - PI-RADS for this lesion = 4/5 * Location: Right, anterior, apex, peripheral zone Allow yourself the time to seek multiple opinions. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Notice of Privacy Practices(Patients & Health Plan Members). 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. I'll post the whole thing, my doc and my own comments, and then cut/paste all my MRI results in case anyone REALLY liked data. 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. Generally, the symptoms can stabilize over time. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Recovery from Prostate Cancer | Bills Story. Prostate cancer is an 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. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Seek Perspective from a Range of Specialists. Bladder: Normal. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. It works. I opted to waive the biopsy, wait 1 year and test again. -------------------------------------------------------- In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Getting a second opinion can sometimes lead to a complete change in diagnosis (such as cancerous to benign or vice versa) in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. 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. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. Tumor Quantifications: C. Prostate, right apex, core biopsy: 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. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. Six weeks later I have the biopsy in his office and a week later I get the results. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. Based on this forum, Im very lucky for this outcome. Generally, the symptoms can stabilize over time. 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. * Adjacent organ invasion: None. Ask us questions on this webpage. The results were ambiguous. 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. Have been told a health condition is not treatable. Prostate, left lateral apex: Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. -------------------------------------------------------- In fact, additional biopsies revealed no additional cancer. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. I'm going to reach out to UCLA to see what they can do. Out of 12 cores, 9 are positive. Im currently 67 years old. Surgeon wants next PSA in 3 months. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. 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! Especially opinions other than those of the first Urologist you see. 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%). When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. :) Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. 9: Prostate, left anterior MRI lesion The .gov means its official. 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. You're also at greater risk of prostate cancer forming before age 50. My plan is to choose quality of treatment over cost of the treatment. 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. One of the problems with second opinions is that insurers may not cover the expense. Other Features: 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. 30%/40% or higher)? I'm leaning towards SBRT. It would be more convenient to use Mayo but I want the best practitioner regardless. What are your opinions of what that is, and where to get it? I hope my story helps anyone out there just starting the process. 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. 5: Prostate, left medial apex All Gleason 6 (3+3). PMC * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? doi: 10.1002/cncr.30412. Confirm biopsy and imaging results with centers of excellence before making any final decisions. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. Patients may experience a fever or chills as a result of the infection. Contact us or find a patient care location. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. prostate cancer; quality of health care; second opinion; specialists; treatment. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. If these do not work, your symptoms could progress and become chronic. My long-term prognosis appears to be good with minimal side effects. In 2006 my PSA was .6. 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. 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. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. Does this also include HIFU, Cryoablation? My thoughts focus on the fact that I have a disabled son who needs my care. According to the doctor it is around 3 mm. Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. intricate disease and not all doctors have the same amount of experience An acute bacterial infection can cause a burning sensation. 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. The treatment of prostate cancer has evolved tremendously. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) - High grade prostatic intraepithelial neoplasia (HGPIN) Radhakrishnan A, Grande D, Mitra N, Pollack CE. My question is--what importance do volume levels play in determining when to move from AS to treatment? I now have my list whittled down to 3. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. Johns Hopkins is home to many of the world's leaders in Pathology. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. This site needs JavaScript to work properly. I've been on AS since April 2016. A fusion biopsy was performed in late May and I just received those results last Thursday. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. What have your doctors told you? Benign Processes: Over 80,000 specimen cases are seen at Johns Hopkins each year. 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. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. 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. Some men have minimal or no symptoms at all. Slightly I am doing one in 6 weeks, regardless. Second opinion Biopsy came after FLA G-9. Am I missing anything? Therefore, the value of these second opinions remains unknown. Request an Appointment 410-955-6100 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. According to The National Institute on Aging, prostate problems are common after age 50. 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. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. Benign prostatic tissue Covid turned the 1 year into 16 months and PSA tested at 7.44 in August 2020, followed by another referral back to the urologist. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). 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. If these do not work, your symptoms could progress and become chronic. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of A. Prostate, right base, core biopsy: You May Like: Sbrt Radiation Therapy Prostate Cancer. 4. 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. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 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. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein.
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