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. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. - High grade prostatic intraepithelial neoplasia (HGPIN) Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. Radhakrishnan A, Grande D, Mitra N, Pollack CE. Also, a second opinion provides the opportunity to get information from someone other than the physician who will be directing treatment, which is usually the main source of information for most patients. A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. Details are here: 4. Prostate, left medial apex: Advances in our understanding of breast cancer have opened up new treatment options or clinical trial opportunities, including targeted drug therapies and tissue-conserving procedures proven to greatly reduce pain and nausea. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Lesion 1: Left mid-base transition zone. !I've pasted a previous update below for background.I just got my PSA results and the numbers are still trending in the right direction. Wow, I sound like a snob now! Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. I didn't study for the test and it's possible some morning activities might have affected my test score :) Dr. Nour is 100% sure that nothing has spread. I was offered to have my first biopsy sent to Johns Hopkins for second opinion and said why not? which came back with Gleason 9 three weeks after having the what we thought was G-7 ablated. 3/3 4K score 19% (high end of intermediate) 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. Have you heard of PRECISE follow up score for an MRI? Im immediately referred to Urologist. My question is--what importance do volume levels play in determining when to move from AS to treatment? It would be more convenient to use Mayo but I want the best practitioner regardless. 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. Does this also include HIFU, Cryoablation? 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. If a targeted biopsy is planned, this lesion can be sampled at the same time. Day 7 after surgery I took my last pain pill. Prostate, right lateral base: Prostatic Adenocarcinoma Perineural invasion is identified 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. I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). Just got my pathology results. * Other 12 slides not sent And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) SMIL radiologist reported nothing found. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov. The people were great. With that alone, I would likely be a candidate for continued Active Surveillance. Enter the last name, specialty or keyword for your search below. -------------------------------------------------------- Benign fibromuscular stroma; no prostatic glands are identified After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) Y'all are in my prayers! 3. 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 . Good Day Everyone. PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? Benign prostatic tissue That is literally the first time I heard that term other than seeing it in my pathology report. * PIRADS v2 Score: 5 The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. And again, most of you tell me time is on my side, so I am comforted in hearing that. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Have been diagnosed with a serious or rare health condition. Bookshelf 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. Do I need a third opinion? 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. I would love to hear from anyone who has been involved in the Chicago study. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. Now, I would like to send Radiology for a similar review. The biopsy took 12 cores, two from each lesion area and 8 randomly. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. C. Prostate, right apex, core biopsy: Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. And it is OK to have paralysis by over-analysis. Then about a month later I started 28 fractions of Proton Radiation.It was painless. (PZ) - normal If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. Prostate, left anterior MRI lesion: So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. Adenocarcinoma: However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. government site. 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. If they have an enlarged colon, their physician can perform a TURP procedure. Secondary Gleason grade: 4 Request an Appointment 410-955-6100 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. 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. Thank you for your understanding and cooperation. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (medial core: 3.5 mm, 30%; lateral core: 2.5 mm, 20%), 0.5 mm to the blue inked tissue edge (the closer) When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. 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. Here's what JH says (same lesion). In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? 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. 4. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Grade Group: 1 Men were asked if they obtained a second opinion from a urologist, and the reasons why. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Metastatic disease considered less likely for this pattern. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. Hope to hear from a bunch of people. 5. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. Prostate, left medial base: * Prostate volume: 22 cc 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. Are considering a treatment that involves significant risks, such as surgery. 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. Brief MRI history. So, I believe I made the right choice. Also indicated everything else was "organ confined." An acute bacterial infection can cause a burning sensation. 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. PROSTATE LESIONS: MM, Much to my dismay my 4th targeted biopsy Oct 12 revealed 5% G4 (upgraded from Grade Group 1 to 2 (Gleason 3+4 intermediate/favorable). Caused me to bleed heavily. 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 . Specimens Submitted: I really just want the results of their innovative PTEN test. 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. This kills both birds with a single stone. Bethesda, MD 20894, Web Policies Total Gleason score: 7 Prostate, right medial apex: I retested in January 2019 and scored 4.20. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. Best practices dictate that you obtain a second confirmatory pathology evaluation. Get a Second Opinion At that point I agreed to the TRUS biopsy which I had on October 10, 2020. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. He also said perinueral invasion, but not extracapsular extension. They replied they are sending the slides but they said they're looking into the DX test and will get back to me once they have that information. This urologist can get you in for surgery next week. I am relatively new to this forum and trying to educate myself as to my best course of treatment. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) * Asked and Dr. said he isn't overly concerned about perineural finding with the grade and it won't impact treatment options or overall prognosis. MEASUREMENTS: 4/16 3T MRI performed (reports/re-reads below) Oncologist. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. - Johns Hopkins Medicine -- Get a Second Opinion Hello everyone. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. 2020 Dec 1;3(12):e2028320. During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. transition zone. doi: 10.1002/cncr.30412. Find more COVID-19 testing locations on Maryland.gov. I tried to send the samples out for genetic testing to Prolaris and Decipher, but there was an ordering error and they never went thru. We will give that a shot and see how it turns out. Benign prostatic tissue Asking about other experience with conflicting Prostate Biopsy Opinions. 8: Prostate, left lateral base How long do you have left? Same with the amount of how much pattern 4. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. 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. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . 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. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. 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 . Contact us or find a patient care location. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. It has been 2.5 years and the PSA has still not doubled as well. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. B. Prostate, right mid, core biopsy: Thank you! 4. The more accurate the information we have, the better our treatment decisions. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Prostate, left lateral apex: Two from one lesion were positive as was one of the two from the other. An acute bacterial infection can cause a burning sensation. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. EDI am now 52 and not quite functioning like I did 4+ years ago. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. There are so many different departments at Hopkins that I don't know the optimal department to contact. Total Gleason score: 6 Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 2. 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. curing cancer, prostate cancer questions johns hopkins hospital, josef issels wikipedia, cancer a second opinion a look at book by josef issels, coping with metastatic cancer cancer net, pdf americans health priorities curing cancer and, what is immunotherapy cancer research institute cri, cancer a second opinion a . NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! Our singular focus on treating cancer, and only cancer, means we have the expertise to confirm a diagnosis or treatment plan and offer options that may not have been considered. * Adjacent organ invasion: None. PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. Recovery from Prostate Cancer | Bills Story. A second opinion can help you make an informed, confident decision about your medical care. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. Am I missing anything? Over 80,000 specimen cases are seen at Johns Hopkins each year. They agreed with the PI-RADS 4. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Got my physical and normal DRE with new Dr. No issues identified. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. P60 MD006900/MD/NIMHD NIH HHS/United States, T32 HL007180/HL/NHLBI NIH HHS/United States, K07 CA151910/CA/NCI NIH HHS/United States, P30 CA016520/CA/NCI NIH HHS/United States, K07 CA163616/CA/NCI NIH HHS/United States. Read books and realize as soon as they are published, they are outdated. Epub 2017 Jun 12. - PI-RADS for this lesion = 4/5 1. This site needs JavaScript to work properly. Doctors are skilled at pitching the treatment they specialize in. Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. I was on active surveillance after a FLA procedure done in 2018. 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. I've been on AS since April 2016. With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. That's the good news. Receiving a second opinion was not associated with perceived quality of prostate cancer care. An accurate diagnosis is essential to ensure the most effective treatment. Pathology reports are subjective. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Especially opinions other than those of the first Urologist you see. Noted that some don't even include on report and should be looked as something to note but not obsess about. Seminal vesicles and other margins are negative for tumor. If anyone has used him, please let me know what your experience was like. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. I opted to waive the biopsy, wait 1 year and test again. Notice of Privacy Practices(Patients & Health Plan Members). What are your opinions of what that is, and where to get it? For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. 1st opinion. A second opinion can accomplish a number of things. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. My other option for treatment is either LDR or HDR brachytherapy. MRI obtained outsideon 04/16/2021. Both Drs and nurses knew what they were doing and had lots of experience. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. A doctor may prescribe surgery or perform an endoscopic procedure. OTHER: None. DRE is always normal. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. My involvement is below maximum of 15% of core. In fact, additional biopsies revealed no additional cancer. And if so, what does being accepted in a AS program look like, do I need to be present at their location? 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. Getting a second opinion can sometimes lead to a complete change in diagnosis (such as cancerous to benign or vice versa) in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. For cancers that are less common, second opinions can offer more treatment options. Our team approach brings together highly experienced prostate cancer experts from across disciplines to collaborate on each patients total care, from diagnosis through treatment and recovery. The primary goal is to be cured with the least toxic, most effective approach. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. I was diagnosed with a 3T MP MRI and a 3T MP MRI guided 4 core biopsy. Finally, things are set and I know what is going to happen. Prostate volume: 17.58 cc My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. Right mid anterior transition zone (PIRADS 2). However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. After a little experimenting I have been able to achieve a partial erection. The urologist offered surgery and radiation as options on 3/10 when we met. A PSA test at time of biopsy revealed my PSA had risen to 6.5. * PIRADS v2 Score: 3 He basically said it was possible, but that he did not agree. 5: Prostate, left medial apex The linear amount of tissue with carcinoma is 23 mm