* PIRADS v2 Score: 3 A few weeks later and just before my meeting with my new Johns Hopkins Dr I get the second opinion results from both biopsy and MRI. 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. Is it done through my doctor or do I do it myself with sending CDs of the MRI? 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? Based on this forum, Im very lucky for this outcome. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. 1. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. E. Prostate, left mid, core biopsy: Sometimes, you may find out about treatment options you didnt know were available. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. A. Prostate, right base, core biopsy: FLA DONE AT FIRST BIOPSY G- 7. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? -------------------------------------------------------- Benign fibromuscular stroma; no prostatic glands are identified 5. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. First 6 week PSA is undetectable. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. * Location: Left, anterior, base to apex, transition zone * Location: Right, anterior, apex, peripheral zone I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. How long do you have left? Other Features: If a targeted biopsy is planned, this lesion can be sampled at the same time. Please enable it to take advantage of the complete set of features! Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. 1. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. 4. 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. If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. Low post-void residual volume is 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. Dr. Erick Walser at University of Texas Medical Center. 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. 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. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." Slight BPH findings. IMPRESSION: - Benign prostatic tissue We are vaccinating all eligible patients. 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. There is hope. The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S. Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them. 5. John, I was diagnosed on 11 December, 2013. She put me in the hospital. 3/3 4K score 19% (high end of intermediate) Call us with any questions: 410-955-2405, ext. 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. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. There are also many reasons why you may want to seek another opinion during the course of your cancer care. Prostate, left lateral apex: Ask your doctor for a copy of your complete medical record. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. 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. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. 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. This teamwork ensures the best possible patient outcomes. * Seminal vesicle invasion: None. !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. Extraprostatic extension: negative 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. Many researchers believe PTEN present is a strong brake on My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. peripheral zone signal intensity on T2-weighted images. Prostate, left medial base: A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. 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. In some situations, insurers will even insist on a second opinion. Surabhi Dangi-Garimella, PhD. It got discussions started and questions answered. Not all cancers are the same and not all treatment plans are absolutely clear. 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. An increase of 1.1 in 3 months is not good news. Benign Processes: Especially opinions other than those of the first Urologist you see. When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. 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. 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. Further, the two tumors in question have not really changed much in size for more than 2 years. 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 biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. Greetings gentlemen! Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? Are you sure you want to block this member? 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) First let me just say what so many others have previously stated, the thought of going on this journey alone is frightening, I cant imagine traveling this road alone. 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. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Thanks for considering. Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach. Low volume post-void residual urine is present in the bladder. It is OK to be overwhelmed with info. Symptoms include leaking and discomfort. 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. We experienced information overload and decision/analysis paralysis. 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. 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. 6: Prostate, left medial base Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? 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. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. Also indicated everything else was "organ confined." PROSTATE LESIONS: Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. Be sure to confirm your diagnosis at a center of excellence. undefined will no longer be visible to you including posts, replies, and photos. A fusion biopsy was performed in late May and I just received those results last Thursday. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. Even if I go the radiation route, should I try for Proton radiation or some other type? And should I treat prostatitis before FLA? He also stated that he would ONLY recommend FLA if done within a trial. But I refuse to sit still, I continue to research and to plan, as best I can. 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. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. I am doing one in 6 weeks, regardless. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. Read books and realize as soon as they are published, they are outdated. Cancer 2017;123:1027-34. doi: 10.1001/jamanetworkopen.2020.28320. This is often the case when the primary physician advises an expensive treatment. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. The primary goal is to be cured with the least toxic, most effective approach. 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. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion You May Like: Prostate Radiation Treatment Side Effects. Instead, I did my homework. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. The total number of cores identified is 3 As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. 2. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. 2020 Dec 1;3(12):e2028320. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. 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. The people were great. We are vaccinating all eligible patients. 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. Brachytherapy Experience with Dr. Albert Chang at UCLA? 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. Metastatic disease considered less likely for this pattern. 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 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. My urologist suggested a couple more PSA tests followed by an MRI. 3 months has passed, and its time for a PSA and a plan to have an MRI. 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. Jonathan Epstein, MD received his doctorate from Boston University. 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. Medical record collection from doctors and hospitals. I appreciate any comments or insight that anyone wants to share. Greatest dimension 2cm. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Benign prostatic tissue 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. Thank you! Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. probably organ confined disease. I have been drinking out of an information fire hose. -------------------------------------------------------- I am 65 and in excellent general health. Seems like a simple request. He schedules appointments with a Radiologist and two local surgeons. Benign prostatic tissue Details are here: Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers. 3. You feel healthy, you arent in pain, you A doctor may prescribe surgery or perform an endoscopic procedure. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. transition zone. -------------------------------------------------------- -------------------------------------------------------- Also these lesions did not abut or touch the wall of the prostate. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. * 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. We will give that a shot and see how it turns out. 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). I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. Because every patient is different, there are several ways to approach prostate cancer treatment. Benign Processes: MRI RE-READ #3 (National Cancer Center of Excellence): While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. The primary goal is to be cured with the least toxic, most effective approach. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. Dr. Jonathan Epstein of Johns Hopkins University Hospital. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. 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. Find more COVID-19 testing locations on Maryland.gov. 10. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Who Should Request a Second Opinion? Fear motivates you to want to treat this as soon as possible. I was on active surveillance after a FLA procedure done in 2018. Noted that some don't even include on report and should be looked as something to note but not obsess about. -------------------------------------------------------- )As for side effectsI occasionally have some urgency/hesitancy having to pee. This is a PI-RADS 5 lesion in HHS Vulnerability Disclosure, Help With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. 1. prostate volume). Epub 2017 Jun 12. 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. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. (Recommended by my oncologist, Dr. Mark Scholz.) We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. * Adjacent organ invasion: None.
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