2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. 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. Noted that some don't even include on report and should be looked as something to note but not obsess about. When people recommend going to a Center of Excellence, believe them. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. 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. Prostate cancer is a slow growing condition. Fear motivates you to want to treat this as soon as possible. After applying exclusion criteria, the final analytic cohort included 2365 respondents. I personally have benefitted from second opinions on my so-called cancer journey. By Dec 2019, my PSA reached 4.13. Hi All, I have been drinking out of an information fire hose. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. As a result, patients struggle to differentiate bias from fact. Atrophy The lesion also shows focal increased permeability. Prostatic Adenocarcinoma 2. Get a Second Opinion What can a second opinion tell me? It is OK to not understand all the terminology. Some men have minimal or no symptoms at all. 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. * Extracapsular extension: None. 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. The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). I guess TWO national centers of excellence are better than one? 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. A fusion biopsy was performed in late May and I just received those results last Thursday. They did 9 patients in Phase I and there have been 12 so far in Phase II. Low volume post-void residual urine is present in the bladder. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Prostate, right lateral base: of tumor in the rectal prostatic angles. When I was diagnosed I really thought that I will live only 2 years. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! Primary Gleason grade: 3 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. 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. 180 days after treatment PSA was .50. * Sloan only sent partial cores, slides 1 and 4. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? * Perineural Invasion detected 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. Covid turned the 1 year into 16 months and PSA tested at 7.44 in August 2020, followed by another referral back to the urologist. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. According to The National Institute on Aging, prostate problems are common after age 50. 3. B. Prostate, right mid, core biopsy: The percentage of tissue with carcinoma is 45% 6: Prostate, left medial base Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. Patients may experience a fever or chills as a result of the infection. Study after study confirms that doctors favor the treatment they are trained to do urologists typically recommend surgery and radiation oncologists recommend radiation. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? 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. No extraprostatic extension. - High grade prostatic intraepithelial neoplasia (HGPIN) - PI-RADS for this lesion = 4/5 And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Prostate, right lateral apex: Conclusions: Get a Second Opinion Just had my appointment today and they are pleased with the results, so far. 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. 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. In fact, additional biopsies revealed no additional cancer. Spent the night in hospital with very little pain after the first couple of hrs. You can find out by reviewing your plan or by reaching out to your insurance company. Cancer. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 1 of 2 cores (lateral core: 4 mm, 35%), 0.1 mm to the blue inked tissue edge I still have some urgency and frequency issues, but I am not complaining too bad. With that alone, I would likely be a candidate for continued Active Surveillance. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. MEASUREMENTS: This is why the prostate is important to the body. After all, it seems like good idea to deal with your cancer sooner rather than later. Possible additional organ confined malignant lesion in right apex Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. :) - 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) 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. Transurethral microwave thermotherapy : In selected patients, microwave energy helps to restructure prostate tissue and alleviate symptoms such as incontinence and voiding dysfunction, 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. So the pathologist suggested a second opinion. You have a rare or unusual cancer. doi: 10.1002/cncr.30412. Pathology reports are subjective. 2. Epub 2018 Mar 28. 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. Benign prostatic tissue Prostate, left anterior MRI lesion: Read books and realize as soon as they are published, they are outdated. From what I've learned from Dr. Scholz videos at PCRI, and from posts on this site it would lead me to believe the DX test is fairly common knowledge. One core had 5%, one 20%, and one 40%. Prostatic Adenocarcinoma Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. 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. Patients may experience a fever or chills as a result of the infection. "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 . Careers. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. My strong preference would be to do FLA again and monitor. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. Race and ethnicity. 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. Biopsy Results: What Do They Mean? - Prostate Cancer Foundation Prostate dimensions: 4.1 x 2.8 x 3.4 cm Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. 1. 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. 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. You receive a secure, private online consultation without leaving home. PROSTATE LESIONS: The presence of any G4 has been my trigger to seek treatment. Also these lesions did not abut or touch the wall of the prostate. Be sure to confirm your diagnosis at a center of excellence. 2016 American Cancer Society. Abstract Context: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Why It's Worth Seeking a Second Opinion for Prostate Cancer Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Also Check: How Old Can You Be To Get Prostate Cancer. Dr. Albert Chang at UCLA appears to be the best in the biz for high dose rate (HDR) focal brachytherapy. Thanks for considering. 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. What are you doing about it? I followed up with the original pathologist to compare and he was more forthcoming. Prostate Cancer | Johns Hopkins Medicine Grade Group: 2 We had the 3T MRI (no coil) and MRI guided biopsy at Sperling in NY, and then had a 2nd Opinion done by Johns Hopkins. * Prostate size: 3.9 x 2.8 x 3. cm No extraprostatic extension. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night.At this point, I am convinced I made the right treatment choiceOHFOR THOSE THAT DON'T KNOW, THE VA HAS MADE REPRODUCTIVE CANCERS A PRESUMPTIVE CONDITION FOR THOSE THAT SERVED IN MOST OF THE WAR ON TERROR LOCATIONS.Good luck fellas and my prayers are with all of you having to contend with this disease. The side effects of the cut, radiate, hormone regime are unacceptable to me. Pingback: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Pingback: Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Your email address will not be published. However, there were no other suspicious areas on MRI. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Where to start for newly diagnosed advance prostate cancer The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. If they have an enlarged colon, their physician can perform a TURP procedure. 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. Here are seven tips for seeking second opinions for prostate cancer: 1. 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. poorly defined margins and intermediate to low T2. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Interesting differences: While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. He never sought treatment for the injury. Asking about other experience with conflicting Prostate Biopsy Opinions. Find more COVID-19 testing locations on Maryland.gov. 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. Second opinions apply to biopsies and imaging as well. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Either the patient or the primary physician can initiate the process of getting a second opinion. Surgeon wants next PSA in 3 months. Second Opinions for Cancer Care - UChicago Medicine They basically said it didn't matter. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. The average age at the time of prostate cancer diagnosis is about 66. I am also doing a vegan diet with additional complementary substances. I have developed an "abscess" on my prostate. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine sharing sensitive information, make sure youre on a federal I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. Other Features: Got my physical and normal DRE with new Dr. No issues identified. Caused me to bleed heavily. The average age at the time of prostate cancer diagnosis is about 66. (TZ) One suspicious area - lesion size: 2cm x 1.4 cm Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Benign Processes: I am unfortunately "officially" joining the club after getting my biopsy results today. The primary goal is to be cured with the least toxic, most effective approach. 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. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). You may also complete an online appointment request form and we'll respond to schedule an appointment. -------------------------------------------------------- 1. Federal government websites often end in .gov or .mil. - High grade prostatic intraepithelial neoplasia (HGPIN) FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. 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. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. * Location: Left, anterior, base to apex, transition zone Anything I am overlooking or need to add to my list of considerations? With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3,500 specialists with extensive experience in all types of cancers. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Read Also: Nhs Prostate Cancer Risk Calculator. Slight BPH findings. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. 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. You May Like: Prostate Radiation Treatment Side Effects.

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