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. Do I need a third opinion? Race and ethnicity. Unbelievable that this happened!!! 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. prostate cancer; quality of health care; second opinion; specialists; treatment. Secondary Gleason grade: 4 I could not get a definitive answer from them on how much, how many cells, or any information. 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. Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it). Reasons for obtaining a second opinion from urologists. EDI am now 52 and not quite functioning like I did 4+ years ago. Second opinions not likely to change prostate cancer treatment It is still important to do your own research. Other: There is trace ascites in the mesosigmoid. You May Like: Sbrt Radiation Therapy Prostate Cancer. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. 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. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Brachytherapy Experience with Dr. Albert Chang at UCLA? 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. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. Both Drs and nurses knew what they were doing and had lots of experience. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. According to The National Institute on Aging, prostate problems are common after age 50. Seminal vesicles are normal. Grade Group: 1 In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Benign prostatic tissue Getting a second opinion from us is easy, convenient, and all done remotely. Generally, the symptoms can stabilize over time. Greetings gentlemen! I suggest for all that hear, "you have cancer" that you seek more opinions! 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. Greatest dimension 0.7cm . 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. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. 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. 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. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Negative cancer in lymph nodes, seminal vesicles, and all margins. Good Luck and God Bless everyone. Nov 7, 2016. Surprisingly, while one in nine men will get diagnosed with prostate cancer in their lifetime1, there are very few doctors who specialize exclusively in treating prostate cancer. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. 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 personally have benefitted from second opinions on my so-called cancer journey. Assessment categories for this lesion: the transition zone. 6. Details are here: 2. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. 1. You're also at greater risk of prostate cancer forming before age 50. Hi All, - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length 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. G. Prostate, lesion #1, core biopsy: Patients may experience a fever or chills as a result of the infection. Primary Gleason grade: 3 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. So, I also sent this MRI result to Johns Hopkins for a second opinion. Unable to load your collection due to an error, Unable to load your delegates due to an error. How important is Oncotype DX test for Gleason 7? Unauthorized use of these marks is strictly prohibited. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Asking for your comments: A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Now its easier than ever to get the answers you need and peace of mind you deserve. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. You're more likely to develop prostate cancers that are more likely to spread. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. 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. Spent the night in hospital with very little pain after the first couple of hrs. 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. 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. After a little experimenting I have been able to achieve a partial erection. Either the patient or the primary physician can initiate the process of getting a second opinion. 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. An acute bacterial infection can cause a burning sensation. doi: 10.1136/bmjopen-2020-044033. DIAGNOSIS: More medical freakouts. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. 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. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Johns Hopkins is home to many of the world's leaders in Pathology. My diagnosis is T2c, Gleason 7 (3+4). No definitive evidence of distant metastatic disease is seen." Four had 60-70%, five have between 5-10%. 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. 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. I hope my story helps anyone out there just starting the process. This has raised some questions on all the scans so far. Especially opinions other than those of the first Urologist you see. There are so many different departments at Hopkins that I don't know the optimal department to contact. This condition causes pain in the lower back and groin area, and may cause urinary retention. 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. Diffusely decreased poorly defined margins and intermediate to low T2. -------------------------------------------------------- Also, infection was noted, so the current PSA is high in part due to prostatitis. * Location: Left, anterior, base to apex, transition zone Seminal vesicles and other margins are negative for tumor. He said that it will improve in the future due to future improvements in the treatments. Have been diagnosed with a serious or rare health condition. See this image and copyright information in PMC. Especially opinions other than those of the first Urologist you see. Slight BPH findings. Have a condition that isnt improving or is getting worse, despite treatment. The review process normally takes several days, after which we will send your slides and other materials are returned. But I did speak to an oncologist who wanted to order Oncotype, which I did. Based on the results, our experts can provide you with an individualized treatment plan before you leave. A report with the diagnosis will be faxed to your doctor. LESION 2 My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. 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. Using the Bullet Volume gives you gland of 25.55. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Federal government websites often end in .gov or .mil. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. However, something is driving my PSA. I've been on AS since April 2016. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? The total number of cores identified is 3 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 linear amount of tissue with carcinoma is 23 mm A newly published paper by Fischer et al. fibromuscular stroma, anterior prostatic contour is smooth. When to move from Active Surveillance to Treatment for Prostate Cancer? Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. There is no extraprostatic extension. 10. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. I officially joined the club with diagnosis on March 21: three small lesions with a GS 6 on one side and both a GS 6 and a GS (3+4) 7 on the other side. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. * PIRADS v2 Score: 5 In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. 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 . I had FLA done after first biopsy which staged me at 3+4 = 7. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Primary Gleason grade: 3 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. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. In other words, the cancer is still contained within the prostate. You feel healthy, you arent in pain, you 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. 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. Before Now the oncologist wants to perform a PSMA Pet Scan. 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. Family history of prostate cancer. The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. 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. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) Please enable it to take advantage of the complete set of features! Find more COVID-19 testing locations on Maryland.gov. - DCE = (+) Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. It can: Confirm your original diagnosis and treatment plan Give you more detail about the type of breast cancer you have and stage it's in. There are lots of lessons learned on the forum. I certainly would - after all, there's a certain brotherhood bond here. My strong preference would be to do FLA again and monitor. Good pathology readings require experience and a high level of expertise. 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. Here are the details: First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. The percentage of Gleason grade 4 and/or 5 is 5 % 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. Slightly But I've had trouble getting Dr. Chang's office to provide any patient referrals. J Am Board Fam Med. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? - 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) Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. This urologist can get you in for surgery next week. My question is--what importance do volume levels play in determining when to move from AS to treatment? My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. A second opinion is part of the education process that is critical for many cancer patients. B. Prostate, right mid, core biopsy: If these do not work, your symptoms could progress and become chronic. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . images and markedly reduced ADC. My plan is to choose quality of treatment over cost of the treatment. Brief MRI history. I can do radiation as a monotherapy. Prostate cancer is the second-most diagnosed cancer in American men. There is no evidence Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Only took Motrin and Tylenol for pain after release. The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. The side effects of the cut, radiate, hormone regime are unacceptable to me. Sometimes, you may find out about treatment options you didnt know were available. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. 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. Why It's Worth Seeking a Second Opinion for Prostate Cancer Confirm biopsy and imaging results with centers of excellence before making any final decisions. Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. Hillen MA, Medendorp NM, Daams JG, Smets EMA. This is not true. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? 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. Dr. Jonathan Epstein of Johns Hopkins University Hospital. Thank you for your participation! And again, most of you tell me time is on my side, so I am comforted in hearing that. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. BASE DATA: 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. Video consultation and written report from your expert. Youve just been diagnosed with prostate cancer. 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%). If I am rested, I find that I am more ready than if I am not. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. 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