While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. Left mid-base transition zone (PIRADS 5). Some specialists have more expertise and more experience than others. 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. Hello. You're also at greater risk of prostate cancer forming before age 50. 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. 1. Potentially inaccurate results can lead to selection of the wrong type of therapy. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. Here are seven tips for seeking second opinions for prostate cancer: 1. FOIA Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. Recovery from Prostate Cancer | Bills Story. Further, among men with low risk disease, we did not observe a significant association between second opinions and receipt of definitive treatment or surgery. Thanks for Everyone's Help, Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. Benign prostatic tissue My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. Benign prostatic tissue As a result, patients struggle to differentiate bias from fact. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. This site needs JavaScript to work properly. Perineural invasion is identified This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. It didnt look at changes of grading of the cancer.The chances for some type of modification based on a second opinion are even greater than the study indicated.Asking for a second opinion could lead to a significant change in surgical or medical intervention, Netto says.Even if the diagnosis error isnt catastrophic, such as advising a patient that he has cancer when he really doesnt, an error in grading can be consequential. My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. doi: 10.1136/bmjopen-2020-044033. doi: 10.1001/jamanetworkopen.2020.28320. All wanted to do what they do, schedule treatment which at this time is only Gleason 6 which I now know is not life threating. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.).
Second Opinion Pathology | MD Anderson Cancer Center Get directions, important phone numbers, locations and more. 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. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. MRI June 2017 again at SMIL. The primary goal is to be cured with the least toxic, most effective approach. I had a very bad experience with an incompetent nurse that did a catheter change. 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. * Size: 1.1 cm A doctor may prescribe surgery or perform an endoscopic procedure. 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. The average age at the time of prostate cancer diagnosis is about 66. Jonathan Epstein, M.D.
Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com 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. Unfortunately, what you do not realize may harm you! Benign Processes: Get a Second Opinion What can a second opinion tell me? 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). You're at greater risk if you're Black or of African ancestry. An acute bacterial infection can cause a burning sensation. These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. He has had a nagging "groin injury" for may years (he played pick up basket ball until he got injured) and we are now wondering if this could be the source of that recurring ache. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. He never sought treatment for the injury. Anyhow, as for treatment, yesterday I met with a Dr. William Wong at Mayo Phoenix. Benign Processes: Overall my PSA is between 4 and 10. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Precision Medicine Center of Excellence for Prostate Cancer, robotic-assisted radical laparoscopic prostatectomies, The Brady Urological Institute and the Johns Hopkins Kimmel Cancer Center take a, Our urologic surgeons have extensive experience performing, Our surgeons, oncologists and radiologists are also world leaders in prostate cancer research, giving patients access to the latest discoveries and. Last year, Epsteins lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions.Netto says patients should be proactive in requesting that doctors take another look.A second opinion can reverse the diagnosis in up to 5 percent of cases for some types of cancers, he says, like those of the breast and pancreas.Diagnosis Errors by the Numbers. The urologist offered surgery and radiation as options on 3/10 when we met. Thankfully, prostate cancer is extremely slow growing. The more accurate the information we have, the better our treatment decisions. Depending on your location, you may be able to have a telemedicine consultation. Benign fibromuscular stroma; no prostatic glands are identified Masks are required inside all of our care facilities. Prior to the results, the oncologist said that the literature shows that a 3+4=7 with less than 5% pattern 4 behaves just like a 3+3=6 and basically is an indolent tumor. Thanks for considering. This Dr is in charge of active surveillance program at JH so I knew that he wouldnt recommend surgery unless it was really needed. Even at the age of 48, he thought I would be a good candidate for AS.
7 Tips for Seeking Second Opinions For Men with Prostate Cancer It has been 2.5 years and the PSA has still not doubled as well. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): You have a rare or unusual cancer. MRI RE-READ #3 (National Cancer Center of Excellence):
Why It's Worth Seeking a Second Opinion for Prostate Cancer I had two no-risk, non-invasive tests: a Free PSA with an adverse score of 9% and a PCA3 test with a disappointing 41. Their opinions are widely held to be definitive. I have selected Focal Laser Ablation as my future (soon) treatment. If pain is present, a digital rectal examination will reveal hard areas. 2 cores from left base of 3+4=7 with only 5% involvement. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. In some situations, insurers will even insist on a second opinion. For cancers that are less common, second opinions can offer more treatment options. The linear amount of tissue with carcinoma is 11 mm We specialize in minimally invasive treatments for prostate cancer such as: We place a high priority on sparing the nerves and tissue around the prostate whenever possible. 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. It's a bit confusing since most experts now don't consider Gleason 6 to be a true cancer, so did i test positive in 2 cores or 4? * IF ANYONE reading this doesn't believe in the value of MRI first and targeted biopsy next then take note that my systematic biopsy cores showed 0 positive in 8 cores and my MRI guided core samples were 6 for 6 being positive! In order to give treatment for each patient with utmost security we would like to announce that currently there will be no visitors allowed.Please note that only one attendant per in-patients is permitted. My thoughts focus on the fact that I have a disabled son who needs my care. Just had my appointment today and they are pleased with the results, so far. Prostatic Adenocarcinoma The total number of cores identified is 3 The percentage of tissue with carcinoma is 45% 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. the transition zone. This has raised some questions on all the scans so far. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Metastatic disease considered less likely for this pattern. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. prostate cancer; quality of health care; second opinion; specialists; treatment. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Second opinions apply to biopsies and imaging as well. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Find more COVID-19 testing locations on Maryland.gov. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: I want to insure that the Imaging was read correctly and nothing was overlooked or missed. 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. 2021 Sep 24;11(9):e044033. 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. 4. Several friends rushed towards surgery and now wish they had the information he provides before they decided to go with such care. So the pathologist suggested a second opinion. Need guidance choosing from multiple treatment options. I choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Two from one lesion were positive as was one of the two from the other. We have a consult on Friday with the 1st opinion doc to review all tests. Epub 2017 Jun 12. (Scores above 55 have a greater than 50% chance of finding clinically significant cancer on a biopsy) The biopsy showed 2 or 3 cores containing HG PIN but no cancer. One Johns Hopkins study showed that out of 14,000 men who had surgery and were found to have Gleason 6 cancer confined to the prostate, "zero of those 14,000 men had lymph node metastases. Benign prostatic tissue Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Cancer patients are encouraged to obtain second opinions before starting treatment.
Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine There is no one-size-fits-all treatment for prostate cancer. Both Drs and nurses knew what they were doing and had lots of experience. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. "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 . Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Especially opinions other than those of the first Urologist you see. 3: Prostate, right medial apex :) A second opinion is part of the education process that is critical for many cancer patients. There are so many different departments at Hopkins that I don't know the optimal department to contact. Unbelievable that this happened!!! As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. Know Your Stage.
In general, a second opinion is a good option for people who have recently received a cancer diagnosis but have not started treatment, as well as for people who have already completed chemotherapy or radiation treatment. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive - Benign prostatic tissue
Second round of Radiation Therapy - t - Advanced Prostate John. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. 3T MRI with coil is done initially, along with a TRUS biopsy. Hello everyone. We are vaccinating all eligible patients. In 2006 my PSA was .6. What have your doctors told you? And should I treat prostatitis before FLA? During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. 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. A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. 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. First 6 week PSA is undetectable. Reinterpretation of imaging scans and lab tests. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. Yet none of my doctors ever mentioned it! 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. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. No extraprostatic extension. Those readings were reported on a second opinion by Dr. Epstein. 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. It's really that simple! Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? The issues in my prostate from the first procedure onward have all been in the same area and the rest of my prostate from the first biopsy and subsequent MRIs onward have never shown any indications of cancer in other areas. * Perineural Invasion also detected My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Benign Processes: A report with the diagnosis will be faxed to your doctor. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. We will then prepare a written recommendation regarding your treatment plans or options. Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers.