The total number of cores with carcinoma is 3 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. My long-term prognosis appears to be good with minimal side effects. Also indicated everything else was "organ confined." I was referred to a urologist and tested again in April at 4.40. If the enlarged prostate is not completely removed, it will shrink. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). Need guidance choosing from multiple treatment options. However, that information will still be included in details such as numbers of replies. As a result, patients struggle to differentiate bias from fact. Greatest dimension 0.7cm . They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. Benign Processes: * PIRADS v2 Score: 3 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. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. IMPRESSION: After all, it seems like good idea to deal with your cancer sooner rather than later. - PI-RADS for this lesion = 4/5 2020 Dec 1;3(12):e2028320. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. Radhakrishnan A, Grande D, Mitra N, Pollack CE. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. So, I believe I made the right choice. You're also at greater risk of prostate cancer forming before age 50. 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. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Intensity: min 148 / Max 459 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. My family physician for years told me that small increases PSA was common so when it went over 4 it didnt bother me and my Dr who was retiring, didnt say anything either. 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. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. * Prostate size: 3.9 x 2.8 x 3. cm Good Day Everyone. U.S. News & World Report ranked the institute #7in the country. Original Sloan Biopsy Results: Just had my appointment today and they are pleased with the results, so far. 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. Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. Find more COVID-19 testing locations on Maryland.gov. Benign Processes: I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. 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. EDI am now 52 and not quite functioning like I did 4+ years ago. Five years ago I had a TURP. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Some specialists have more expertise and more experience than others. Four had 60-70%, five have between 5-10%. Low volume post-void residual urine is present in the bladder. Second opinions from urologists for prostate cancer: Who gets - PubMed Some men may have an enlarged prostate but not notice it. I suggest for all that hear, "you have cancer" that you seek more opinions! I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. Therefore, the value of these second opinions remains unknown. 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. 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. Masks are required inside all of our care facilities. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. The site is secure. A fusion biopsy was performed in late May and I just received those results last Thursday. There were several areas of interest - but nothing in seminal vesicles, lymph, or bones. Patients may experience a fever or chills as a result of the infection. I didn't study for the test and it's possible some morning activities might have affected my test score :) Breast Cancer: When to Get a Second Opinion - WebMD Check Biopsy and Imaging Results for Accuracy. Total Gleason score: 7 Hi All, The total number of cores with carcinoma is 3 (I must say that those low numbers concern me a bit.) While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. Receiving a second opinion was not associated with perceived quality of prostate cancer care. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. Greetings gentlemen! Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. Include Your Primary Care Physician as Member of Your Treatment Team. Ask us questions on this webpage. DRE is always normal. No extraprostatic extension. 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. But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). It is OK to be scared. Fear motivates you to want to treat this as soon as possible. An acute bacterial infection can cause a burning sensation. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. We are vaccinating all eligible patients. Notice of Privacy Practices(Patients & Health Plan Members). Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Therefore, the value of these second opinions remains unknown. Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. __________________________________________________________________________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. It took me awhile but minutes ago received my second opinion from Johns Hopkins. 6. Background: Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. Grade Group: 2 1st opinion"Note is made of sclerotic changes in the right pubic bone adjacent to the symphysis pubis having only low-level activity and this is thought to be more likely due to degenerative changes rather than bony metastasis." Reinterpretation of imaging scans and lab tests. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). A report with the diagnosis will be faxed to your doctor. Prostate cancer is the second-most diagnosed cancer in American men. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. So, I asked the Radiologist if she will schedule one for me. Benign Processes: J Am Board Fam Med. Good Morning Brothers- Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. Be well. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. According to the doctor it is around 3 mm. Got my physical and normal DRE with new Dr. No issues identified. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. For cancers that are less common, second opinions can offer more treatment options. 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. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. Some men have minimal or no symptoms at all. He recommended waiting and watching at that time due to the lower PSA reading. 1. Jonathan Epstein, MD received his doctorate from Boston University. PELVIC LYMPH NODES: No adenopathy. 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. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. Get a Second Opinion | Johns Hopkins Pathology Youve just been diagnosed with prostate cancer. Do second opinions matter in prostate cancer care? - ecancer Am I missing anything? The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Any input on this would really be appreciated. But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. 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. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. Not all men with Gleason 8-10 disease are going to do badly after You may choose to consider a second opinion if you: 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. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. 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. I now have my list whittled down to 3. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. If these do not work, your symptoms could progress and become chronic. I guess TWO national centers of excellence are better than one? The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! Just took time off and then life happened.Thanks in advance for the insights. It also rules out Brachytherapy. I tried to send the samples out for genetic testing to Prolaris and Decipher, but there was an ordering error and they never went thru. Accessibility Thank you for your understanding and cooperation. very activerun/cycle 6 days a week I'm Gleason 3+4=7, and I believed only 2 cores tested positive. 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. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. 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. 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. Extraprostatic extension: negative Allow yourself the time to seek multiple opinions. Yet none of my doctors ever mentioned it! Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Here are the details: Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. Benign prostatic tissue We can help with your case. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? I'm turning 58 in one week. At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. 1. Second opinion Johns Hopkins? - Prostate cancer They basically said it didn't matter. For all other cancer appointments, please call: 1-855-702-8222. Hello everyone. I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. I have posted here before, now with an update. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine C. Prostate, right apex, core biopsy: Dr. Dan Sperling - New York. doi: 10.1002/cncr.30412. Perineural invasion is identified The linear amount of tissue with carcinoma is 23 mm 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. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. 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. I had a 3T mp MRI with coil bed, without and with contrast, at Emory on March 3. Medical record collection from doctors and hospitals. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. Get a Second Opinion Two weeks later I meet with my Johns Hopkins Dr. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. The treatment of prostate cancer has evolved tremendously. According to The National Institute on Aging, prostate problems are common after age 50. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. I am 62 years old. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. BONES: No suspicious osseous 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm You May Like: Prostate Cancer External Beam Radiation Side Effects. For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. Thanks! If I am rested, I find that I am more ready than if I am not. - 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 I just turned 71 in February. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. asymmetric central zone tissue more pronounced on the left. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. 9: Prostate, left anterior MRI lesion Find more COVID-19 testing locations on Maryland.gov. A week later had catheter removed and had no bladder leakage problems. Unable to load your collection due to an error, Unable to load your delegates due to an error. Benign prostatic tissue Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. Not all cancers are the same and not all treatment plans are absolutely clear. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. I could not get a definitive answer from them on how much, how many cells, or any information. PROSTATE LESIONS: The urologist offered surgery and radiation as options on 3/10 when we met. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. Should You Exercise When Youre Expecting? Following the advice of all on here, I need a team of doctors to manage my care. Total Gleason score: 6 When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! Left mid-base transition zone (PIRADS 5). 7. FLA DONE AT FIRST BIOPSY G- 7. 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. prostate cancer; quality of health care; second opinion; specialists; treatment. Just got my pathology results. feel the clock ticking. Many researchers believe PTEN present is a strong brake on Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 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. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Benign prostatic tissue Lesion 1: Left mid-base transition zone. Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? prostate volume). They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. E. Prostate, left mid, core biopsy: (Recommended by my oncologist, Dr. Mark Scholz.) The total number of cores identified is 3 There is no bony or bulky nodal disease in the pelvis Prostatic Adenocarcinoma Doctors are skilled at pitching the treatment they specialize in. If they have an enlarged colon, their physician can perform a TURP procedure. Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. -------------------------------------------------------- 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. :) This urologist can get you in for surgery next week. Metastasis. Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com Generally, the symptoms can stabilize over time. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. 3. 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. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive Prostate Cancer Grading: Second Opinion For Cancer Treatment And Care | CTCA | City of Hope But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. 1. Required fields are marked *, PHONE 310-827-7707 decision on a single medical opinion or the first appointment you get, you may A enlarged prostate can also cause blockages in the urethra. Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. We are vaccinating all eligible patients. 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. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. Be sure to confirm your diagnosis at a center of excellence. 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. What are your opinions of what that is, and where to get it? 3. Second Opinions for Cancer Care - UChicago Medicine Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. MY THOUGHTS AND ANYTHING DOCTOR NOTED: Its in your best interest to ask for another look at a cancer diagnosisIf youve recently been diagnosed with cancer, its wise to ask for a second opinion on your pathology specimen.Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause.