6. JAMA Netw Open. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): This championship swimmer sought a second opinion at Johns Hopkins. 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. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Some specialists have more expertise and more experience than others. EDI am now 52 and not quite functioning like I did 4+ years ago. 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. 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. For cancers that are less common, second opinions can offer more treatment options. 2. In some situations, insurers will even insist on a second opinion. Thank you! probably organ confined disease. Secondary Gleason grade: 3 Out of 12 cores, 9 are positive. Diffuse probable benign peripheral zone changes limit evaluation for decision on a single medical opinion or the first appointment you get, you may Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. HHS Vulnerability Disclosure, Help I am relatively new to this forum and trying to educate myself as to my best course of treatment. I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. 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." 6: Prostate, left medial base My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. 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. 3. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). There is hope. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Lesion 2: Right mid anterior transition zone. And it is OK to have paralysis by over-analysis. Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists. F. Prostate, left apex, core biopsy: Results: Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. Generally, the symptoms can stabilize over time. After applying exclusion criteria, the final analytic cohort included 2365 respondents. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. I'm turning 58 in one week. C. Prostate, right apex, core biopsy: Brief MRI history. So the pathologist suggested a second opinion. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. Pathology reports are subjective. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. My new Dr however didnt order PSA so I asked him for one. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. It was easy. 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. Prostatic Adenocarcinoma These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." Pathology Second Opinion-J.Epstein,M.D. Pathologist-Johns Hopkins Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. Sometimes, you may find out about treatment options you didnt know were available. Prostate, left lateral apex: I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. Note respondents were able to, MeSH With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. "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 guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. He basically said it was possible, but that he did not agree. Am I wrong? 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. 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. A blocked urethra can also damage the kidneys. I am also doing a vegan diet with additional complementary substances. In severe cases, a catheter may be required to relieve the symptoms. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. -------------------------------------------------------- PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Surgeon wants next PSA in 3 months. Prostate, right anterior MRI lesion: Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. 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. I was on active surveillance after a FLA procedure done in 2018. Over kill and redundancy I know, but it's my money, my prerogative. Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? Overall PIRADS Score: 2/5 I was referred to a urologist and tested again in April at 4.40. However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. Cancer 2017;123:1027-34. I'd like to talk with former patients who have gone through the procedure. After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. My prior Prolaris study (2018) before the FLA was very low risk. The results seemed fairly benign and my urologist and I decided to continue to monitor with 2 more PSA tests and then consider an MRI in April 2021. * Location: Right, anterior, apex, peripheral zone the transition zone. So, I believe I made the right choice. Same with the amount of how much pattern 4. Benign prostatic tissue !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. Second opinion Biopsy came after FLA G-9. 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. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). Have you heard of PRECISE follow up score for an MRI? And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. Got my physical and normal DRE with new Dr. No issues identified. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. It is OK to be scared. Original Sloan Biopsy Results: I didn't study for the test and it's possible some morning activities might have affected my test score :) Keywords: If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. Benign Processes: Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. 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. Would you like email updates of new search results? Extracapsular extension: The prostatic capsule is preserved. Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. 8600 Rockville Pike 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. I have been drinking out of an information fire hose. Grade Group: 2 I was confident I was making the right decision. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Seminal vesicles are normal. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. The total number of cores identified is 3 PMC Due to the spread of the Coronavirus worldwide and the first confirmed case of the Coronavirus disease in Turkey, the executive team of the Anadolu Medical Center has taken preventive measures to protect the patients and their relatives. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! Benign fibromuscular stroma; no prostatic glands are identified Details are here: In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. * Extracapsular extension: Possible involvement of the anterior Consultation with your nurse care manager. Johns Hopkins is home to many of the world's leaders in Pathology. Prostate, right lateral base: fibromuscular stroma, anterior prostatic contour is smooth. More medical freakouts. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Thanks! 180 days after treatment PSA was .50. I would love to hear from anyone who has been involved in the Chicago study. Find more COVID-19 testing locations on Maryland.gov. Prostate, right lateral apex: Reasons for obtaining a second opinion from urologists. A second opinion can help you make an informed, confident decision about your medical care. Prostate volume: 17.58 cc You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Primary Gleason grade: 3 I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. 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. If the enlarged prostate is not completely removed, it will shrink. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. and transmitted securely. The people were great. 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. Johns Hopkins second opinion - nothing found. And it is OK to have paralysis by over-analysis. Greatest dimension 0.7cm . 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. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion Men with a college education or beyond also were more likely to cite wanting more information about their cancer as a motivation for a second opinion . The total number of cores with carcinoma is 3 There is no bony or bulky nodal disease in the pelvis A man with a father or brother who had prostate cancer is twice as likely to develop the disease. My question is--what importance do volume levels play in determining when to move from AS to treatment? 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. Secondary Gleason grade: 4 I am 62 years old. 3. 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. Caused me to bleed heavily. Consult Fees In some cases, additional testing may be required. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. You can find out by reviewing your plan or by reaching out to your insurance company.

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