In the mean time my PSA was movingno longer static, but never back up to 6. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. 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. Assessment categories for this lesion: - High grade prostatic intraepithelial neoplasia (HGPIN) Move ahead to Dec 2020. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) 7. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. You May Like: Prostate Cancer External Beam Radiation Side Effects. Does this also include HIFU, Cryoablation? A blocked urethra can also damage the kidneys. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. To schedule an in-person visit for a second opinion or to determine if a telemedicine consultation is possible, call: 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. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). Discover what's to love about Charm City for yourself. Anyway, would appreciate knowing how to contact Johns Hopkins. J Am Board Fam Med. Race and ethnicity. He was right. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. 2: Prostate, right lateral base They replied they are sending the slides but they said they're looking into the DX test and will get back to me once they have that information. Experts believe that this study is the first in history to have achieved such results. It will be interesting to see, I think. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. 5. Benign fibromuscular stroma; no prostatic glands are identified An acute bacterial infection can cause a burning sensation. 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. 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. 2. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . 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. transition zone. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. * Gleason Score: 3+3, Slide 1 (vs. Sloan's 3+4) Based on this forum, Im very lucky for this outcome. 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. Extracapsular extension: The prostatic capsule is preserved. 3. - 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) I am 65 and in excellent general health. Greetings gentlemen! I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. Obviously the Covid 19 issue is playing a part in all of our decisions. 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. Metastasis. This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues. Total Gleason score: 7 2 cores from left base of 3+4=7 with only 5% involvement. Every year I got a PSA and DRE during my annual physical. His second opinion just came back. A report with the diagnosis will be faxed to your doctor. Doctors can review their peers treatment suggestions and explain why they agree or disagree. information. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. I suggest for all that hear, "you have cancer" that you seek more opinions! Interesting differences: Second opinion Biopsy came after FLA G-9. 3: Prostate, right medial apex It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. I say bullshit to them. Following his residency in anatomic pathology at The Johns Hopkins Hospital in Baltimore, Maryland, and a fellowship in oncologic pathology at Memorial Sloan Kettering Cancer Center in New York., he then joined the staff at The Johns Hopkins Hospital and has been there his entire career. The lesion also shows focal increased permeability. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. desired outcome. 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? Is it done through my doctor or do I do it myself with sending CDs of the MRI? Just got my pathology results. A. Prostate, right base, core biopsy: This is the most common urinary tract problem in men under 50, and the third most common in men over 65. 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. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! Your email address will not be published. Check Biopsy and Imaging Results for Accuracy. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Brief MRI history. Does every biopsy provide a Gleason Score? Following the advice of all on here, I need a team of doctors to manage my care. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. __________________________________________________________________________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. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. 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. Bladder: Normal. - High grade prostatic intraepithelial neoplasia (HGPIN) PSA that brought me to this was 7.1. 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 am unfortunately "officially" joining the club after getting my biopsy results today. Patient-Driven Second Opinions in Oncology: A Systematic Review. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. Here's what JH says (same lesion). 6: Prostate, left medial base Want confirmation about a diagnosis or treatment. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. In order to give treatment for each patient with utmost security we would like to announce that currently there will be no visitors allowed.Please note that only one attendant per in-patients is permitted. Jonathan Epstein, MD received his doctorate from Boston University. FOIA 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. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. No extraprostatic extension. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. The neurovascular bundles are intact. As a result, patients struggle to differentiate bias from fact. Two from one lesion were positive as was one of the two from the other. - DCE = (+) official website and that any information you provide is encrypted TRANSPERINEAL MRI GUIDED BIOPSY RESULTS We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. The .gov means its official. Left mid-base transition zone (PIRADS 5). 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. 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. 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. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. 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. Benign Processes: 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. of tumor in the rectal prostatic angles. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. On the first scan (post FLA) a lesion was identified by the local radiologist that performed the scan, but the FLA radiologist that performed my procedure was over reading and monitoring my care and stated strongly that there was no cancer. 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. Jonathan Epstein, M.D. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. images and markedly reduced ADC. You May Like: Sbrt Radiation Therapy Prostate Cancer. -------------------------------------------------------- I now have my list whittled down to 3. When people recommend going to a Center of Excellence, believe them. About 60% of prostate cancers occur in people older than 65. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. This has only low-level nonspecific activity with SUV max of 2.05 and may be due to degenerative changes at the symphysis pubis." asymmetric central zone tissue more pronounced on the left. Got my physical and normal DRE with new Dr. No issues identified. 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. 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. Greetings gentlemen! 3. Prostate volume: 17.58 cc We experienced information overload and decision/analysis paralysis. Then about a month later I started 28 fractions of Proton Radiation.It was painless. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (combined: 10.5 mm, 40%), 0.2 mm to the blue inked tissue edge Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. Many researchers believe PTEN present is a strong brake on And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. Am I wrong? And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. P60 MD006900/MD/NIMHD NIH HHS/United States, T32 HL007180/HL/NHLBI NIH HHS/United States, K07 CA151910/CA/NCI NIH HHS/United States, P30 CA016520/CA/NCI NIH HHS/United States, K07 CA163616/CA/NCI NIH HHS/United States. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Read books and realize as soon as they are published, they are outdated. Dont Miss: Can Prostate Problems Cause Burning Urination, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Johns Hopkins Prostate Cancer Second Opinion, treat rare and complex conditions through breakthrough fetal procedures, Function Of The Prostate Gland And Seminal Vesicles, Best Treatment For Intermediate Prostate Cancer, How Old Can You Be To Get Prostate Cancer, New Treatments For Stage 4 Prostate Cancer, Prostate Radiation Treatment Side Effects, Can Prostate Problems Cause Burning Urination, Prostate Cancer Spread To Skull Prognosis, Life Expectancy Stage 4 Prostate Cancer No Treatment, Diagnostic Procedures For Prostate Cancer. I wanted to keep my options open. Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. Confirm biopsy and imaging results with centers of excellence before making any final decisions. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. 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. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 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. Ask us questions on this webpage. Hi All, Over 80,000 specimen cases are seen at Johns Hopkins each year. 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. 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. -------------------------------------------------------- My diagnosis is T2c, Gleason 7 (3+4). Other labs for second . Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. This may include imaging, blood tests, prior treatment, and pathology reports. Benign Processes: You feel healthy, you arent in pain, you 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. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. Younger men also sought the 'best' doctor. 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. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Find more COVID-19 testing locations on Maryland.gov. A newly published paper by Fischer et al. 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. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Be well. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. My thoughts focus on the fact that I have a disabled son who needs my care. 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. Call us with any questions: 410-955-2405, ext. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken There are also some cases of the test showing no depletion but being wrong. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Seems like a simple request. (Recommended by my oncologist, Dr. Mark Scholz.) Especially opinions other than those of the first Urologist you see. The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). * Seminal vesicle invasion: None. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. SO. Explore our state-of-the-art patient care facilities in the Sheikh Zayed Tower. * Size: 1.5 cm Overall PIRADS Score: 2/5 We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. So the pathologist suggested a second opinion. * Prostate size: 3.9 x 2.8 x 3. cm Anyone with insight into this and advice? These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." Include Your Primary Care Physician as Member of Your Treatment Team. If anyone has used him, please let me know what your experience was like. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. There is no one-size-fits-all treatment for prostate cancer. My prior Prolaris study (2018) before the FLA was very low risk. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. But I've had trouble getting Dr. Chang's office to provide any patient referrals. Allow yourself the time to seek multiple opinions. 2. PI-RADS v2 score: 5. Prostate, right lateral base: The treatment of prostate cancer has evolved tremendously. When I was diagnosed I really thought that I will live only 2 years. He recommended waiting and watching at that time due to the lower PSA reading. It is still important to do your own research. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Caused me to bleed heavily. The side effects of the cut, radiate, hormone regime are unacceptable to me. (I must say that those low numbers concern me a bit.) Epub 2017 Jun 12. 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. * Size: 1.1 cm 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. This urologist can get you in for surgery next week. * Location: Left, anterior, base to apex, transition zone 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. My mind goes all over the place as to why this is. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. They won't be offended, and they may even be able to recommend a specialist for you to see. 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 I still have some urgency and frequency issues, but I am not complaining too bad. Y'all are in my prayers! 2020 Dec 1;3(12):e2028320. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Dont Miss: New Treatments For Stage 4 Prostate Cancer. ---------------------------------------------------- But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Expert review of your case by a Cleveland Clinic specialist. One of the problems with second opinions is that insurers may not cover the expense. You Prostate cancer is a slow growing condition. 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. Thank you! Over 80,000 specimen cases are seen at Johns Hopkins each year. The symptoms of acute bacterial prostatitis are similar to those of CPPS. 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. Two 1cc tumors, gleason score 3+4 each, one in each lobe. 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. When to move from Active Surveillance to Treatment for Prostate Cancer? I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. I'm trying to figure out why the PSA keeps rising. An accurate diagnosis is essential to ensure the most effective treatment. One Johns Hopkins study showed that out of 14,000 men who had surgery and were found to have Gleason 6 cancer confined to the prostate, "zero of those 14,000 men had lymph node metastases. Two weeks later I meet with my Johns Hopkins Dr. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2