2: Prostate, right lateral base Following the advice of all on here, I need a team of doctors to manage my care. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Comments appreciated, Possible additional organ confined malignant lesion in right apex And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. I've been on AS since April 2016. Results: They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. 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. The results of Oncotype came back and it was a bad report. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." 2. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) * Adjacent organ invasion: None. How long do you have left? Younger men also sought the 'best' doctor. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. It works. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. The neurovascular bundles are intact. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. A second opinion is part of the education process that is critical for many cancer patients. Johns Hopkins Health - Second Opinions, Second Chances, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, High Blood Pressure May Take Its Toll on Your Kidneys. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. doi: 10.1136/bmjopen-2020-044033. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. 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. H. Prostate, lesion #2, core biopsy: Include Your Primary Care Physician as Member of Your Treatment Team. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. He schedules appointments with a Radiologist and two local surgeons. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. 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. They won't be offended, and they may even be able to recommend a specialist for you to see. 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. 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. So, I asked the Radiologist if she will schedule one for me. John. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Anyone with insight into this and advice? 3. restricted diffusion. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. So off I went to see a community urologist who performed a needle biopsy in his office. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. The linear amount of tissue with carcinoma is 23 mm Especially opinions other than those of the first Urologist you see. -------------------------------------------------------- Adenocarcinoma: I find that when I'm trapped in the cockpit not able to use the bathroom for a long time is when I experience that most. 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." So, Radiation Oncologist prescribed Cialis 5mg, daily. I wish the VA would be more informative about this disease they owe it to our veterans. If the enlarged prostate is not completely removed, it will shrink. Epub 2010 Oct 20. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. I really just want the results of their innovative PTEN test. 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. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? I had FLA done after first biopsy which staged me at 3+4 = 7. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Thanks, 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. ZERO - The End of Prostate Cancer Support Community. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. * Other 12 slides not sent 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. They did 9 patients in Phase I and there have been 12 so far in Phase II. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Second Opinions for Cancer Care - UChicago Medicine PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems. 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. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. Benign prostatic tissue The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! 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. Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC I'm going to reach out to UCLA to see what they can do. Dont Miss: Screening For Prostate Cancer Icd 10. BJU Int. Find more COVID-19 testing locations on Maryland.gov. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." This shows very high signal intensity on the diffusion-weighted This is often the case when the primary physician advises an expensive treatment. 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. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. Best practices dictate that you obtain a second confirmatory pathology evaluation. 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. Tumor Quantifications: His second opinion just came back. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. My experience at Johns Hopkins was awesome. We will then prepare a written recommendation regarding your treatment plans or options. I was referred to a urologist and tested again in April at 4.40. I have developed an "abscess" on my prostate. Also, their protocol would be another biopsy, but he was comfortable with the image and velocity of PSA that he didn't have to have one to start treatmentand I was pretty hesitant (given the image and PSA) to take ADT, and didn't see a biopsy changing my mind regarding treatment and/or ADT.Oh. Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. Get a Second Opinion 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. So the pathologist suggested a second opinion. Greatest dimension 2cm. fibromuscular stroma, anterior prostatic contour is smooth. ORIGINAL MRI REPORT (local radiology group): 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. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. Reasons for obtaining a second opinion from urologists. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine Note respondents were able to choose more than one reason. However, there are also many more options for treatment and these options are more complicated than in the past. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. 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 . So fingers crossed. 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%). Johns Hopkins second opinion - nothing found. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! 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. Good pathology readings require experience and a high level of expertise. 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. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). I talked with Dr. Epstein who expressed Johns Hopkins' conservative views to not underestimate GS 6 and to consider surgery and/or radiation that have been used successfully for many years in saving lives. Primary Gleason grade: 3 I have had a CT of the pelvic area - negative and a whole body bone scan - negative. Benign Processes: SMIL radiologist reported nothing found. Unbelievable that this happened!!! Prostate volume: 17.58 cc Make an appointment: 410-955-5222 Coordinating with your Treating Physician 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. Breast Cancer: When to Get a Second Opinion - WebMD Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! * Size: 1.1 cm Benign Processes: 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%). You think your doctor is underestimating how serious your cancer is. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. Primary Gleason grade: 3 Prostate, right anterior MRI lesion: focal peripheral zone lesions. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. After applying exclusion criteria, the final analytic cohort included 2365 respondents. D. Prostate, left base, core biopsy: Men were asked if they obtained a second opinion from a urologist, and the reasons why. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. Just had my appointment today and they are pleased with the results, so far. All Gleason 6 (3+3). LESION 2 __________________________________________________________________________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. 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. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. 1. Because I had an implant in my ear, they would only give me a 1.5T MRI. I'm Gleason 3+4=7, and I believed only 2 cores tested positive. Potentially inaccurate results can lead to selection of the wrong type of therapy. Both Drs and nurses knew what they were doing and had lots of experience. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. 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. -------------------------------------------------------- Yet none of my doctors ever mentioned it! Prostate dimensions: 4.1 x 2.8 x 3.4 cm Prostate, left lateral base: Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. I can do radiation as a monotherapy. You're also at greater risk of prostate cancer forming before age 50. I now have my list whittled down to 3. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. We are vaccinating all eligible patients. DIAGNOSIS: As a result, patients struggle to differentiate bias from fact. It hasn't let me down. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. Two weeks later I meet with my Johns Hopkins Dr. If these do not work, your symptoms could progress and become chronic. Hillen MA, Medendorp NM, Daams JG, Smets EMA. 7 Tips for Seeking Second Opinions For Men with Prostate Cancer Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. Dont Miss: New Treatments For Stage 4 Prostate Cancer. 8. 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. I retested in January 2019 and scored 4.20. Video consultation and written report from your expert. The percentage of tissue with carcinoma is 45% 3: Prostate, right medial apex Did robotic radical prostatectomy 1/25/12. Got my physical and normal DRE with new Dr. No issues identified. The results were ambiguous. Also, their protocol would be another biopsy, but he was comfortable with the image and velocity of PSA that he didn't have to have one to start treatmentand I was pretty hesitant (given the image and PSA) to take ADT, and didn't see a biopsy changing my mind regarding treatment and/or ADT.Oh.