It is OK to be overwhelmed with info. Nov 7, 2016. I'm leaning towards SBRT. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. This kills both birds with a single stone. He is the past president of the International Society of Urological Pathology. fibromuscular stroma, anterior prostatic contour is smooth. 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. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. More medical freakouts. 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. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. They find that one of my 5-10% Gleason 6 core is actually a 50% Gleason 7(3+4) and the MRI was so cloudy with blood from original biopsy they said they couldnt determine much. Is it done through my doctor or do I do it myself with sending CDs of the MRI? Thank you for your understanding and cooperation. Greetings gentlemen! Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. 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. Masks are required inside all of our care facilities. 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. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. A week later had catheter removed and had no bladder leakage problems. Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com I wish the VA would be more informative about this disease they owe it to our veterans. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. A enlarged prostate can also cause blockages in the urethra. Prostate Cancer | Johns Hopkins Brady Urological Institute Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. -------------------------------------------------------- MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine The out-of-pocket cost may be in the $300 range (insurance may not cover it), and it is a simple matter to call your urologist to forward the slides to them. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. With that alone, I would likely be a candidate for continued Active Surveillance. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Asking for your comments: They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. Prostatic Adenocarcinoma * Location: Right, anterior, apex, peripheral zone Fear motivates you to want to treat this as soon as possible. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of According to the doctor it is around 3 mm. It works. 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. Hi All, We have sought a second opinion and all tests are being reviewed by that second team.My question has to do with the symphysis pubis. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Many thanks for that. and transmitted securely. I retested in January 2019 and scored 4.20. Prurigo Nodularis Cancer: What's the Link? - Verywell Health A. Prostate, right base, core biopsy: In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? TRANSPERINEAL MRI GUIDED BIOPSY RESULTS Jonathan Epstein, M.D. Younger men also sought the 'best' doctor. 2. - DWI-ADC = 4/5 Everything seems to be on track to remove the cancer and be cured! 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. Either the patient or the primary physician can initiate the process of getting a second opinion. I luckily found this webpage and I started reading everything I could get my hands on. I'll post the whole thing, my doc and my own comments, and then cut/paste all my MRI results in case anyone REALLY liked data. Dont Miss: New Treatments For Stage 4 Prostate Cancer. Men were asked if they obtained a second opinion from a urologist, and the reasons why. Prostatic Adenocarcinoma My other option for treatment is either LDR or HDR brachytherapy. I made the appointments. It's really that simple! 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. If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results. Request an Appointment 410-955-6100 I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. I would appreciate hearing from that 2.8% out there who have an intraductal component. He was right. Race and ethnicity. My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. In order to receive appropriate treatment, patients must understand the treatment options that are available. Thank you, After more than three years on active surveillance, I've pretty much decided to have focal brachytherapy for my prostate cancer. 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. Now its easier than ever to get the answers you need and peace of mind you deserve. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. If they have an enlarged colon, their physician can perform a TURP procedure. 3/5 At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Do any of you have an opinion or actual experience with any of the three listed below? MY THOUGHTS AND ANYTHING DOCTOR NOTED: It will be interesting to see, I think. Unfortunately, what you do not realize may harm you! 2: Prostate, right lateral base No extraprostatic extension. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Call us with any questions: 410-955-2405, ext. 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. Get a Second Opinion What can a second opinion tell me? 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. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. Tumor Quantifications: If pain is present, a digital rectal examination will reveal hard areas. You think your doctor is underestimating how serious your cancer is. Second round of Radiation Therapy - t - Advanced Prostate 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. * Adjacent organ invasion: None. International Patients: How to Request a Remote Second Opinion Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. 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? It is OK to not understand all the terminology. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. 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. DIAGNOSIS: Prostate Cancer | Johns Hopkins Medicine The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. Video consultation and written report from your expert. 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. The total number of cores identified is 3 * Gleason Score: 3+3 (2 of 6 specimens) When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. Find more COVID-19 testing locations on Maryland.gov. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasn't spread outside of the prostate. I just received a second opinion report from Johns Hopkins. Please enable it to take advantage of the complete set of features! 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. Second Opinions for Cancer Care - UChicago Medicine Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? official website and that any information you provide is encrypted Their opinions are widely held to be definitive. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Cancer. Both Drs and nurses knew what they were doing and had lots of experience. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. Below is the link with instructions and the authorization form for you to use with your doctor. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. When to move from Active Surveillance to Treatment for Prostate Cancer? Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. 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. One of the problems with second opinions is that insurers may not cover the expense. 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. Time moves fast when dealing with cancer, but Doctors dont. The .gov means its official. That's the good news. A doctor may prescribe surgery or perform an endoscopic procedure. What are your opinions of what that is, and where to get it? In the United States, prostate cancer is among the most common cancers found in men. 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. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Johns Hopkins is home to many of the world's leaders in Pathology. Overall PIRADS Score: 2/5 If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? Check Biopsy and Imaging Results for Accuracy. Generally, the symptoms can stabilize over time. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. I had a follow up 3T MRI guided biopsy on March 18 at Emory. But I did speak to an oncologist who wanted to order Oncotype, which I did. 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. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. The linear amount of tissue with carcinoma is 11 mm Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. Many researchers believe PTEN present is a strong brake on A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. LESION 2 Every year I got a PSA and DRE during my annual physical. Symptoms include leaking and discomfort. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. There is no extraprostatic extension. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . PSA that brought me to this was 7.1. 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.