This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Dr. Nour is 100% sure that nothing has spread. Therefore, the value of these second opinions remains unknown. According to The National Institute on Aging, prostate problems are common after age 50. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. The results were ambiguous. No definitive evidence of distant metastatic disease is seen." FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. C. Prostate, right apex, core biopsy: This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. This may include imaging, blood tests, prior treatment, and pathology reports. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! This is often the case when the primary physician advises an expensive treatment. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. Thank you! They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. My strong preference would be to do FLA again and monitor. 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. As soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. So fingers crossed. 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. Intensity: min 148 / Max 459 Discover what's to love about Charm City for yourself. It was easy. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. So the pathologist suggested a second opinion. Doctors can review their peers treatment suggestions and explain why they agree or disagree. B. Prostate, right mid, core biopsy: Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. My question is--what importance do volume levels play in determining when to move from AS to treatment? Possible additional organ confined malignant lesion in right apex Even at the age of 48, he thought I would be a good candidate for AS. That's the good news. Thanks to all of you for sharing! First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. Second opinions offer different things in different circumstances, Dr. Matasar says. 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%). 8: Prostate, left lateral base 4. MRI RE-READ #2 (VERY VERY well respected radiologist): Potentially inaccurate results can lead to selection of the wrong type of therapy. So, I also sent this MRI result to Johns Hopkins for a second opinion. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine We can help with your case. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. Thank you for your participation! My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. Second Opinions & Consultations - Brain Tumor | Johns Hopkins Pathology 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! The biopsy took 12 cores, two from each lesion area and 8 randomly. E. Prostate, left mid, core biopsy: Consult Fees In some cases, additional testing may be required. Epub 2018 Mar 28. Benign prostatic tissue 3T MRI with coil is done initially, along with a TRUS biopsy. 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. Prostate, right lateral apex: 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. 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. Please don't hesitate to make any observations or ask questions. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. Either the patient or the primary physician can initiate the process of getting a second opinion. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. the transition zone. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). The total number of cores with carcinoma is 3 Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. My first PSA was 8.03. Low volume post-void residual urine is present in the bladder. We specialize in minimally invasive procedures to treat BPH, including: For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success. NONE of the many radiation oncologists, surgeons or urologists I've spoken with in my journey have ever mentioned the term to me so I had to look it up. Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. With that alone, I would likely be a candidate for continued Active Surveillance. Benign Processes: Benign prostatic tissue and transmitted securely. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. You may also complete an online appointment request form and we'll respond to schedule an appointment. This condition causes pain in the lower back and groin area, and may cause urinary retention. The study was published online Nov. 7 in the journal Cancer. Comments appreciated, Benign Processes: Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. doi: 10.1136/bmjopen-2020-044033. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. My mind goes all over the place as to why this is. 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. Same with the amount of how much pattern 4. The linear amount of tissue with carcinoma is 11 mm Thanks, Prostate cancer is an 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. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? 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. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . Emotional outlook is fragile at times and straight clinical approach of doctors does not help. 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? Urology. It didnt look at changes of grading of the cancer.The chances for some type of modification based on a second opinion are even greater than the study indicated.Asking for a second opinion could lead to a significant change in surgical or medical intervention, Netto says.Even if the diagnosis error isnt catastrophic, such as advising a patient that he has cancer when he really doesnt, an error in grading can be consequential. 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'm going to reach out to UCLA to see what they can do. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. 3/3 4K score 19% (high end of intermediate) Specimens Submitted: First 6 week PSA is undetectable. Just got my pathology results. All views would be appreciated. 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. We are vaccinating all eligible patients. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. 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. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. No extraprostatic extension. An acute bacterial infection can cause a burning sensation. Prostate volume: 17.58 cc Extraprostatic extension: negative 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Reinterpretation of imaging scans and lab tests. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). Are considering a treatment that involves significant risks, such as surgery. Atrophy It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. It works. ---------------------------------------------------------- However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. Unfortunately, monetary incentives create biases that can work against patients best interests. information. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. There are so many different departments at Hopkins that I don't know the optimal department to contact. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. Original Sloan Biopsy Results: In general, a second opinion is a good option for people who have recently received a cancer diagnosis but have not started treatment, as well as for people who have already completed chemotherapy or radiation treatment. So my question for you is have you ever heard of PRECISE and if so what should I make of it? MY THOUGHTS AND ANYTHING DOCTOR NOTED: Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. The review process normally takes several days, after which we will send your slides and other materials are returned. You have a rare or unusual cancer. Required fields are marked *, PHONE 310-827-7707 All wanted to do what they do, schedule treatment which at this time is only Gleason 6 which I now know is not life threating. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. BONES: No suspicious osseous 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. My long-term prognosis appears to be good with minimal side effects. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. I was diagnosed with a 3T MP MRI and a 3T MP MRI guided 4 core biopsy. - Benign prostatic tissue If they have an enlarged colon, their physician can perform a TURP procedure. - High grade prostatic intraepithelial neoplasia (HGPIN) The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. 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. Five years ago I had a TURP. 5. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . There is no bony or bulky nodal disease in the pelvis But I refuse to sit still, I continue to research and to plan, as best I can. I'm 58 yrs old and had a TRUS random biopsy October 2020 after my PSA continually stayed between 4.4 and 8, and PHI score was 126. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. 2. 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. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has 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. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? So now things are getting exciting. Fear, confusion and uncertainty set in. Last checkup (July 2022) my PSA was .46 and it is currently at .32.I am still eating primarily a plant based diet (only lean meats/cheeses/eggs about 10% of my diet) and maintaining steady weight and I am still quite active physically.As for symptomswith 5mg Daily Cialis the occasional ED symptoms have pretty much gone away. There is no one-size-fits-all treatment for prostate cancer. 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. 8. We can help with your case. 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. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. And thanks again for making this such a great support group! 4. It hasn't let me down. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. 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. advising or treating it. Also these lesions did not abut or touch the wall of the prostate. * Other 12 slides not sent Bring All Labs/Notes to Each Appointment. Greetings gentlemen! Watch: Are supplements good for prostate health? The total number of cores with carcinoma is 3 If they have an enlarged colon, their physician can perform a TURP procedure. When to move from Active Surveillance to Treatment for Prostate Cancer? Masks are required inside all of our care facilities. Receiving a second opinion was not associated with perceived quality of prostate cancer care. I luckily found this webpage and I started reading everything I could get my hands on. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. 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. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. An increase of 1.1 in 3 months is not good news. * Prostate size: 3.9 x 2.8 x 3. cm Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Masks are required inside all of our care facilities. (I must say that those low numbers concern me a bit.) 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. Best practices dictate that you obtain a second confirmatory pathology evaluation. How important is Oncotype DX test for Gleason 7? AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. 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. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. 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. transition zone. I would love to hear from anyone who has been involved in the Chicago study. However, that information will still be included in details such as numbers of replies. When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. World J Urol. 6. 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. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. Over 80,000 specimen cases are seen at Johns Hopkins each year. 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. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. 5. Should You Exercise When Youre Expecting? 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? Have a condition that isnt improving or is getting worse, despite treatment. According to the study, one in every 600 diagnoses showed mistakes.This study only addressed major changes in diagnoses, such as a diagnosis of cancer being reversed to no cancer, says Johns Hopkins pathologist George Netto, M.D. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. Just had my appointment today and they are pleased with the results, so far. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). Here are seven tips for seeking second opinions for prostate cancer: Before getting a second opinion, its important to know your stage of prostate 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. MRI RE-READ #3 (National Cancer Center of Excellence): Assessment categories for this lesion: Based on this forum, Im very lucky for this outcome. 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. Y'all are in my prayers! Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. 3. I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find. See this image and copyright information in PMC. How long do you have left? I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. 7 Tips for Seeking Second Opinions For Men with Prostate Cancer I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. FLA DONE AT FIRST BIOPSY G- 7. Perineural invasion is identified 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. A blocked urethra can also damage the kidneys. 2. It is OK to be overwhelmed with info. Surgeon wants next PSA in 3 months. If I am rested, I find that I am more ready than if I am not. ORIGINAL MRI REPORT (local radiology group): Im immediately referred to Urologist. prostate volume). I wanted to keep my options open. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. government site. 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. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. Because every patient is different, there are several ways to approach prostate cancer treatment. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. There is no extraprostatic extension. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. 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. 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 suggest for all that hear, "you have cancer" that you seek more opinions! Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. However, something is driving my PSA. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. Our singular focus on treating cancer, and only cancer, means we have the expertise to confirm a diagnosis or treatment plan and offer options that may not have been considered. - Perineural invasion is present Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. Unable to load your collection due to an error, Unable to load your delegates due to an error. Men were asked if they obtained a second opinion from a urologist, and the reasons why. Accessibility In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. Recovery from Prostate Cancer | Bills Story. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Patients may experience a fever or chills as a result of the infection. Second opinions not likely to change prostate cancer treatment (Recommended by my oncologist, Dr. Mark Scholz.) By basing a treatment 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. But I've had trouble getting Dr. Chang's office to provide any patient referrals. Stanford Medicine Online Second Opinion Program curing cancer, prostate cancer questions johns hopkins hospital, josef issels wikipedia, cancer a second opinion a look at book by josef issels, coping with metastatic cancer cancer net, pdf americans health priorities curing cancer and, what is immunotherapy cancer research institute cri, cancer a second opinion a . Move ahead to Dec 2020. Ramsey SD, Zeliadt SB, Fedorenko CR, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fairweather ME, Thompson IM, Keane TE, Penson DF. Brief MRI history. Prostatic Adenocarcinoma Is it done through my doctor or do I do it myself with sending CDs of the MRI? Would you like email updates of new search results? What are your opinions of what that is, and where to get it? Find more COVID-19 testing locations on Maryland.gov. "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 . I am also doing a vegan diet with additional complementary substances. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. 6: Prostate, left medial base The presence of any G4 has been my trigger to seek treatment. Six weeks later I have the biopsy in his office and a week later I get the results. Jonathan Epstein, MD received his doctorate from Boston University. A enlarged prostate can also cause blockages in the urethra. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. 5: Prostate, left medial apex 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. Wow, I sound like a snob now! BASE DATA: Race and ethnicity. Youve just been diagnosed with prostate cancer. Getting A Second Opinion On Your Pathology Report - Cancer ABCs Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care.
Malik Thomas Obituary, Articles J
Malik Thomas Obituary, Articles J