No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. The total number of cores identified is 3 We can help with your case. 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? J Am Board Fam Med. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. 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. 2. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Also indicated everything else was "organ confined." Now Im still ignorant and dont really know a Gleason from a Duck, so when the Dr says your treatment is radiation or surgery Im devastated. -------------------------------------------------------- And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Get a Second Opinion: Johns Hopkins Kimmel Cancer Center Dont Miss: Is Coffee Bad For Your Prostate. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Consult Fees In some cases, additional testing may be required. 8: Prostate, left lateral base A newly published paper by Fischer et al. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. The study was published online Nov. 7 in the journal Cancer. Greatest dimension 0.7cm . Second Opinions in Prostate Cancer - American Council on Science and Health Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. Question anemia. - High grade prostatic intraepithelial neoplasia (HGPIN) And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. Seminal vesicles are normal. Benign Processes: My diagnosis is T2c, Gleason 7 (3+4). I am relatively new to this forum and trying to educate myself as to my best course of treatment. This teamwork ensures the best possible patient outcomes. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. You're also at greater risk of prostate cancer forming before age 50. Prostate cancer is the second-most diagnosed cancer in American men. -------------------------------------------------------- One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. Low post-void residual volume is All Gleason 6 (3+3). 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. Dont Miss: New Treatments For Stage 4 Prostate Cancer. 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. However, that information will still be included in details such as numbers of replies. This is often the case when the primary physician advises an expensive treatment. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. A blocked urethra can also damage the kidneys. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. and I have already proven to myself that my body is good at cell mutation, so I wanted to be careful.At the 3 year mark (6 months after last MRI), my PSA spiked to > 6. Second Opinions for Cancer Care - UChicago Medicine asymmetric central zone tissue more pronounced on the left. He is the past president of the International Society of Urological Pathology. -------------------------------------------------------- While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Patients may experience a fever or chills as a result of the infection. 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. Ask us questions on this webpage. Find a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine In My Opinion? Get A Second Opinion | ZERO Prostate Cancer Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. Johns Hopkins Prostate Cancer Second Opinion Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. If pain is present, a digital rectal examination will reveal hard areas. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. E. Prostate, left mid, core biopsy: 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. peripheral zone signal intensity on T2-weighted images. If pain is present, a digital rectal examination will reveal hard areas. Best wishes to all those whose concerns for the day are far more serious than mine. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. 3T MRI with coil is done initially, along with a TRUS biopsy. However, learning more about prostate cancer and prostate-related health issues can help optimize health. Therefore, the value of these second opinions remains unknown. What are you doing about it? Got my physical and normal DRE with new Dr. No issues identified. One of the problems with second opinions is that insurers may not cover the expense. See this image and copyright information in PMC. Radhakrishnan A, Grande D, Mitra N, Pollack CE. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . -------------------------------------------------------- Unauthorized use of these marks is strictly prohibited. World J Urol. How important is Oncotype DX test for Gleason 7? Have been told a health condition is not treatable. This urologist can get you in for surgery next week. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. DIAGNOSIS: 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. 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. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. Greatest dimension 2cm. 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. Prostate Cancer | Johns Hopkins Medicine I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. There is hope. Hillen MA, Medendorp NM, Daams JG, Smets EMA. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. Doctors can review their peers treatment suggestions and explain why they agree or disagree. 4/16 3T MRI performed (reports/re-reads below) 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. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. The percentage of tissue with carcinoma is 70% NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. So the pathologist suggested a second opinion. 5. It is OK to be overwhelmed with info. 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. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. You May Like: Sbrt Radiation Therapy Prostate Cancer. I had FLA done after first biopsy which staged me at 3+4 = 7. I'd like to talk with former patients who have gone through the procedure. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. Second Opinion Pathology | MD Anderson Cancer Center We have a consult on Friday with the 1st opinion doc to review all tests. A new study by researchers at the Johns Hopkins University has found that . 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. Benign fibromuscular stroma; no prostatic glands are identified But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). Thanks, BigD. Details are here: His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. And if so, what does being accepted in a AS program look like, do I need to be present at their location? The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. Did robotic radical prostatectomy 1/25/12. 3. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. Thanks to all of you for sharing! I want to insure that the Imaging was read correctly and nothing was overlooked or missed. Prostate, left medial base: Grade Group: 2 Total Gleason score: 6 I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. Epub 2017 Jun 12. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . You May Like: Prostate Radiation Treatment Side Effects. Surabhi Dangi-Garimella, PhD. Johns Hopkins second opinion - nothing found. Good Luck and God Bless everyone. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. It works. I certainly would - after all, there's a certain brotherhood bond here. The problem is that all 3 pathologies noted an intraductal component. 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. 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. 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. Y'all are in my prayers! Masks are required inside all of our care facilities. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. Notice of Privacy Practices(Patients & Health Plan Members). It was easy. Benign Processes: Are considering a treatment that involves significant risks, such as surgery. Seminal vesicles and other margins are negative for tumor. Suspicion for malignancy left anterior base-to-apex transition zone; - Perineural invasion is present Transurethral microwave thermotherapy : In selected patients, microwave energy helps to restructure prostate tissue and alleviate symptoms such as incontinence and voiding dysfunction, 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. It is OK to be scared. * Perineural Invasion detected So the pathologist suggested a second opinion. 1. It is OK to be overwhelmed with info. Men were asked if they obtained a second opinion from a urologist, and the reasons why. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. Before For these reasons, it is a good idea for HMO members to get a second opinion and make sure they are informed about clinical trials or other promising new treatments. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 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. We are vaccinating all eligible patients. Caused me to bleed heavily. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. 180 days after treatment PSA was .50. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. It is very rare (<3% of all prostrate cancers) and potentially very lethal (one study showed that 59% of men in the study with Gleason scores of 5 had died within 3 years and it had metastasized in 13% of the remaining men). 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. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Consultation with your nurse care manager. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. doi: 10.1002/cncr.30412. the transition zone. BASE DATA: 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. doi: 10.1002/cncr.30412. SO. And it is OK to have paralysis by over-analysis. 4. Just got my pathology results. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Cleveland Clinics Virtual Second Opinions program connects you to an expert physician who specializes in your specific health needs. Call us with any questions: 410-955-2405, ext. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. Find more COVID-19 testing locations on Maryland.gov. In other words, the cancer is still contained within the prostate. Explore our state-of-the-art patient care facilities in the Sheikh Zayed Tower. 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. For all other cancer appointments, please call: 1-855-702-8222. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. You think another treatment might be available. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." !I've pasted a previous update below for background.I just got my PSA results and the numbers are still trending in the right direction. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. Overall my PSA is between 4 and 10. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. It will be interesting to see, I think. As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". Breast Cancer: When to Get a Second Opinion - WebMD Unable to load your collection due to an error, Unable to load your delegates due to an error. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. 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. 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. Dr. Dan Sperling - New York. Extraprostatic extension: negative It starts many years ago. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Y'all are in my prayers! )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. 8600 Rockville Pike Atrophy Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. 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. 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. 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.