This condition causes pain in the lower back and groin area, and may cause urinary retention. Radhakrishnan A, Grande D, Mitra N, Pollack CE. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. Now the oncologist wants to perform a PSMA Pet Scan. Details are here: Some of the more common treatments that you and your doctor may discuss include: Prostate cancer experts at the Brady Urological Institute have created tools that help patients and doctors across the world assess risk and make treatment decisions. The total number of cores identified is 3 My questions are: I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. Be well. My long-term prognosis appears to be good with minimal side effects. Bring All Labs/Notes to Each Appointment. transition zone. Thanks for Everyone's Help, In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . I am relatively new to this forum and trying to educate myself as to my best course of treatment. 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." So the pathologist suggested a second opinion. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. Your doctor is not a specialist in your type of . Have been diagnosed with a serious or rare health condition. 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. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. poorly defined margins and intermediate to low T2. Some men may have an enlarged prostate but not notice it. Thankfully, prostate cancer is extremely slow growing. I worked out every day. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. Prostate Cancer Grading: But if I include the 3+3=6 cores then 4 cores tested positive and that moves me into the basic teal category and no longer a strong candidate for AS. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine * Other 12 slides not sent Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. Jonathan Epstein, MD received his doctorate from Boston University. 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. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. I retested in January 2019 and scored 4.20. Some men have minimal or no symptoms at all. PROSTATE LESIONS: Five years ago I had a TURP. Other Features: - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (combined: 10.5 mm, 40%), 0.2 mm to the blue inked tissue edge Here's what JH says (same lesion). not hear all the viable treatment options or receive the most up to date Accessibility After a little experimenting I have been able to achieve a partial erection. International Patients: How to Request a Remote Second Opinion Good Morning Brothers- Perineural invasion is identified Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. Dr. Erick Walser at University of Texas Medical Center. 2: Prostate, right lateral base An increase of 1.1 in 3 months is not good news. This shows very high signal intensity on the diffusion-weighted Watch: Are supplements good for prostate health? Recently diagnosed a Gleason 3 + 3. Find more COVID-19 testing locations on Maryland.gov. Lesion 2: Right mid anterior transition zone. My diagnosis is T2c, Gleason 7 (3+4). But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. 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." Notice of Privacy Practices(Patients & Health Plan Members). I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. Have a condition that isnt improving or is getting worse, despite treatment. We have a consult on Friday with the 1st opinion doc to review all tests. To schedule an in-person visit for a second opinion or to determine if a telemedicine consultation is possible, call: In addition to cancer, our urologic team provides second opinions regarding urinary stone disease, urinary tract reconstruction, incontinence, male infertility and sexual health, and many other urologic conditions or procedures. My prior Prolaris study (2018) before the FLA was very low risk. 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. -------------------------------------------------------- Adenocarcinoma: Dr. Dan Sperling - New York. He also said perinueral invasion, but not extracapsular extension. I'm turning 58 in one week. 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. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. Prostate, right anterior MRI lesion: I have requested a second pathologist's opinion from Johns Hopkins based on feedback from this forum. Youve just been diagnosed with prostate cancer. He recommended waiting and watching at that time due to the lower PSA reading. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. My goals are to control PCa, to minimize side effects, and to keep options open in the future. 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. The average age at the time of prostate cancer diagnosis is about 66. Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. focal peripheral zone lesions. I guess TWO national centers of excellence are better than one? With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. Left mid-base transition zone (PIRADS 5). We will then prepare a written recommendation regarding your treatment plans or options. I am unfortunately "officially" joining the club after getting my biopsy results today. There is no one-size-fits-all treatment for prostate cancer. Director of Surgical Pathology- Johns Hopkins, http://pathology.jhu.edu/department/services/secondopinion.cfm, The guy I used along with everyone else is Jonathan Epstein, M.D. However, learning more about prostate cancer and prostate-related health issues can help optimize health. Receiving a second opinion was not associated with perceived quality of prostate cancer care. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. It hasn't let me down. Even if I go the radiation route, should I try for Proton radiation or some other type? Second opinion on biopsy slides - malecare.org We will give that a shot and see how it turns out. 5. 4. 180 days after treatment PSA was .50. According to the study, one in every 600 diagnoses showed mistakes.This study only addressed major changes in diagnoses, such as a diagnosis of cancer being reversed to no cancer, says Johns Hopkins pathologist George Netto, M.D. You 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? MRI obtained outsideon 04/16/2021. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! 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. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. If they have an enlarged colon, their physician can perform a TURP procedure. and transmitted securely. Pathology Second Opinion-J.Epstein,M.D. Pathologist-Johns Hopkins They agreed with the PI-RADS 4. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. 6. Second opinions offer different things in different circumstances, Dr. Matasar says. It is OK to not understand all the terminology. The results of Oncotype came back and it was a bad report. 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. Doctors are skilled at pitching the treatment they specialize in. 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. Prurigo Nodularis Cancer: What's the Link? - Verywell Health Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? Treatment options include immunotherapy, 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. You're also at greater risk of prostate cancer forming before age 50. 1st opinion. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Second opinions from urologists for prostate cancer: Who gets - PubMed Over kill and redundancy I know, but it's my money, my prerogative. 24.5 BMI If I am rested, I find that I am more ready than if I am not. Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri Where to start for newly diagnosed advance prostate cancer No extraprostatic extension. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. 1. Prostate, left anterior MRI lesion: Prostate cancer is a slow growing condition. Is it done through my doctor or do I do it myself with sending CDs of the MRI? 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. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. Last checkup (July 2022) my PSA was .46 and it is currently at .32.I am still eating primarily a plant based diet (only lean meats/cheeses/eggs about 10% of my diet) and maintaining steady weight and I am still quite active physically.As for symptomswith 5mg Daily Cialis the occasional ED symptoms have pretty much gone away. Based on this forum, Im very lucky for this outcome. When I was diagnosed I really thought that I will live only 2 years. Generally, the symptoms can stabilize over time. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Video consultation and written report from your expert. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. 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. ORIGINAL MRI REPORT (local radiology group): Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. But I did speak to an oncologist who wanted to order Oncotype, which I did. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. Depending on your location, you may be able to have a telemedicine consultation. 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%). 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. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Surgery took about 3 hrs. You may also complete an online appointment request form and we'll respond to schedule an appointment. Medical record collection from doctors and hospitals. 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.