He also stated that he would ONLY recommend FLA if done within a trial. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. An increase of 1.1 in 3 months is not good news. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. I made the appointments. I luckily found this webpage and I started reading everything I could get my hands on. Some pathologists have more experience than others. Pathology reports are subjective. Have been told a health condition is not treatable. 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. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Seek Perspective from a Range of Specialists. I have posted here before, now with an update. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . Am I missing anything? 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. present in bladder. What are you doing about it? They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. 3. My PSA over time has been creeping up over time (1.8 - 5/16, 1.0 8/17, 2.68 8/18, 2.9 12/18, 3.28 2/19, 3.01 8/19, 3.65 2/20, 3.31 6/20, 3.88 12/20) but I was frankly a bit shocked when I received word that I have cancer. He said that it will improve in the future due to future improvements in the treatments. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. It also rules out Brachytherapy. D. Prostate, left base, core biopsy: They find that one of my 5-10% Gleason 6 core is actually a 50% Gleason 7(3+4) and the MRI was so cloudy with blood from original biopsy they said they couldnt determine much. Benign Processes: Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. 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.). And just this week, 1 YEAR post treatment, it is .46. Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. We are vaccinating all eligible patients. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Family history of prostate cancer. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. peripheral zone signal intensity on T2-weighted images. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. * Extracapsular extension: None. There is no extraprostatic extension. Allow yourself the time to seek multiple opinions. I personally have benefitted from second opinions on my so-called cancer journey. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. 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 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.). We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. 2. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. Benign prostatic tissue You May Like: Prostate Radiation Treatment Side Effects. He never sought treatment for the injury. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Possible additional organ confined malignant lesion in right apex Read books and realize as soon as they are published, they are outdated. 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. C. Prostate, right apex, core biopsy: Some men have minimal or no symptoms at all. A report with the diagnosis will be faxed to your doctor. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS Im also wondering why no one has scheduled me for MRI to see what biopsy missed. Some of the more common treatments that you and your doctor may discuss include: Prostate cancer experts at the Brady Urological Institute have created tools that help patients and doctors across the world assess risk and make treatment decisions. When to move from Active Surveillance to Treatment for Prostate Cancer? 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. Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it). Yet none of my doctors ever mentioned it! Also, infection was noted, so the current PSA is high in part due to prostatitis. 9. It is OK to be overwhelmed with info. A second opinion can accomplish a number of things. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. Low post-void residual volume is Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. MY THOUGHTS AND ANYTHING DOCTOR NOTED: I am also talking with Dr Nour and Dr. Walser and possibly others to see if I am a good candidate for Focal Laser Ablation. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: Over 80,000 specimen cases are seen at Johns Hopkins each year. A enlarged prostate can also cause blockages in the urethra. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. I made the appointments. Slight BPH findings. Greetings gentlemen! G. Prostate, lesion #1, core biopsy: We are vaccinating all eligible patients. __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. This is a PI-RADS 5 lesion in I am 62 years old. Because I had an implant in my ear, they would only give me a 1.5T MRI. 10. Consultation with your nurse care manager. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. What have your doctors told you? I'm trying to figure out why the PSA keeps rising. Hello, I apologize upfront for the length of this post, but I was recently diagnosed with prostate cancer (T2C) and figure more information is better than not enough. 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. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. 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? I recently sent my Pathology Slides to Dr. Epstein for a Second Review. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? Best wishes to all those whose concerns for the day are far more serious than mine. Ozzieville (Michael), Hello All and thanks for being here~This is my first post.My husband was diagnosed with PC (adenocarcinoma with Extensive Intraductal Carcinoma Present) a few weeks ago. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Can it be salvaged or are the risks of cancer too high? Day 7 after surgery I took my last pain pill. A new study by researchers at the Johns Hopkins University has found that . Prostate, right lateral apex: The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. -------------------------------------------------------- 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. Radhakrishnan A, Grande D, Mitra N, Pollack CE. A PSA test at time of biopsy revealed my PSA had risen to 6.5. 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. In fact, additional biopsies revealed no additional cancer. Based on the results, our experts can provide you with an individualized treatment plan before you leave. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. We will give that a shot and see how it turns out. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. The study was published online Nov. 7 in the journal Cancer. official website and that any information you provide is encrypted have no symptoms, and yet you have cancer? We will then prepare a written recommendation regarding your treatment plans or options. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. Please don't hesitate to make any observations or ask questions. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. Recovery from Prostate Cancer | Bills Story. -------------------------------------------------------- 3: Prostate, right medial apex 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm MRI June 2017 again at SMIL. 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. Got my physical and normal DRE with new Dr. No issues identified. 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. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. As a result, patients struggle to differentiate bias from fact. OTHER: None. - Perineural invasion is present (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) And if so, what does being accepted in a AS program look like, do I need to be present at their location? So, Radiation Oncologist prescribed Cialis 5mg, daily. 7: Prostate, left lateral apex I have developed an "abscess" on my prostate. Atrophy They won't be offended, and they may even be able to recommend a specialist for you to see. Fear motivates you to want to treat this as soon as possible. Cancer patients are encouraged to obtain second opinions before starting treatment. SO. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Intensity: min 148 / Max 459 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. PROSTATE LESIONS: 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. Depending on your location, you may be able to have a telemedicine consultation. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. I was 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. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Some men may have an enlarged prostate but not notice it. Should You Exercise When Youre Expecting? 6. The average age at the time of prostate cancer diagnosis is about 66. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. Conclusions: I wish the VA would be more informative about this disease they owe it to our veterans. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! 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. If pain is present, a digital rectal examination will reveal hard areas. PMC It is OK to be scared. It was easy. Move ahead to Dec 2020. Total Gleason score: 6 The people were great. This is why the prostate is important to the body. Masks are required inside all of our care facilities. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Wondering if any of the "gurus" here want to take a stab at looking at this and see if they agree that it says what I think it says (I will be following up with doctor(s) to get their opinion, and I waive all HIPAA rights by allowing this to be seen). Receiving a second opinion was not associated with perceived quality of prostate cancer care. Surgeon wants next PSA in 3 months. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. This site needs JavaScript to work properly. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). Also indicated everything else was "organ confined." Include Your Primary Care Physician as Member of Your Treatment Team. - 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 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 . You may also complete an online appointment request form and we'll respond to schedule an appointment. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. Cancer 2017;123:1027-34. Bethesda, MD 20894, Web Policies Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Good Luck and God Bless everyone. It hasn't let me down. 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. "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 . It is OK to be scared. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Left mid-base transition zone (PIRADS 5). We are vaccinating all eligible patients. If they have an enlarged colon, their physician can perform a TURP procedure. A second opinion can help you make an informed, confident decision about your medical care. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." He basically said it was possible, but that he did not agree. restricted diffusion. It starts many years ago. There are also many reasons why you may want to seek another opinion during the course of your cancer care. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). My first PSA was 8.03. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. 1st opinion.
