johns hopkins prostate cancer second opinion

He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Enter the last name, specialty or keyword for your search below. 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. Oncologist. Good Luck and God Bless everyone. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. I followed up with the original pathologist to compare and he was more forthcoming. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. Sought Johns Hopkins second opinion of pathology slides. THANKS! Prostatic Adenocarcinoma A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. Tumor Quantifications: I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. Prostate volume: 17.58 cc Second opinions offer different things in different circumstances, Dr. Matasar says. If the enlarged prostate is not completely removed, it will shrink. Hello everyone. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Move ahead to Dec 2020. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. transition zone. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. Consultation with your nurse care manager. 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. You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. Extracapsular extension: The prostatic capsule is preserved. 3. If these do not work, your symptoms could progress and become chronic. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. The average age at the time of prostate cancer diagnosis is about 66. 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. Second Opinion For Cancer Treatment And Care | CTCA | City of Hope You May Like: Best Treatment For Intermediate Prostate Cancer. I worked out every day. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of government site. Note respondents were able to, MeSH 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 side effects of the cut, radiate, hormone regime are unacceptable to me. IMPRESSION: images and markedly reduced ADC. A man with a father or brother who had prostate cancer is twice as likely to develop the disease. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. You can find out by reviewing your plan or by reaching out to your insurance company. Did robotic radical prostatectomy 1/25/12. Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? ZERO - The End of Prostate Cancer Support Community. Sometimes, you may find out about treatment options you didnt know were available. Had a little complication a day after release, excessive blood/clots in urine. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. Original Sloan Biopsy Results: 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Wow, I sound like a snob now! asymmetric central zone tissue more pronounced on the left. !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. My question is regarding the results of an MRI guided biopsy into a distinct tumor vs. subsequent Oncotype Dx Results. I am already positively surprised that I am still alive 4.5 years after my diagnosis. PSA had increased to 5.4. Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. 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. 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. * Perineural Invasion also detected Radhakrishnan A, Grande D, Mitra N, Pollack CE. In order to receive appropriate treatment, patients must understand the treatment options that are available. 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. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. My plan is to choose quality of treatment over cost of the treatment. Pathology reports are subjective. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. radiation, active surveillance, surgery, hormone therapy, and more. Please enable it to take advantage of the complete set of features! A blocked urethra can also damage the kidneys. Overall PIRADS Score: 2/5 Hi All, Include Your Primary Care Physician as Member of Your Treatment Team. There are also many reasons why you may want to seek another opinion during the course of your cancer care. 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. ---------------------------------------------------------- !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. An accurate diagnosis is essential to ensure the most effective treatment. The total number of cores with carcinoma is 3 2. Six weeks later I have the biopsy in his office and a week later I get the results. If these do not work, your symptoms could progress and become chronic. - High grade prostatic intraepithelial neoplasia (HGPIN) I am doing one in 6 weeks, regardless. JAMA Netw Open. Had my PSA remained static I'd have remained on AS and had I grown a Target Lesion I'd have sought focal treatment.This science is emerging and only getting better. Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com Conclusions: Low volume post-void residual urine is present in the bladder. Thank you! When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. Reasons for getting a second opinion include: You want to be sure you have explored all options. Experts believe that this study is the first in history to have achieved such results. 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. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. doi: 10.1136/bmjopen-2020-044033. Keywords: So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. Reasons for obtaining a second opinion from urologists. Call us with any questions: 410-955-2405, ext. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. International Patients: How to Request a Remote Second Opinion We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. I don't know if the FLA could affect the results, or if it was just done because it was not in the study parameters of the test. A week later had catheter removed and had no bladder leakage problems. 1. - Benign prostatic tissue Greetings gentlemen! BASE DATA: Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. 3: Prostate, right medial apex 3. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. * 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. Read Also: Long Term Side Effects Of Brachytherapy For Prostate Cancer. Doctors are skilled at pitching the treatment they specialize in. Im currently 67 years old. 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? I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. 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. 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. The percentage of tissue with carcinoma is 70% 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. Do second opinions matter in prostate cancer care? - ecancer Dont Miss: Screening For Prostate Cancer Icd 10. The presence of any G4 has been my trigger to seek treatment. 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). HHS Vulnerability Disclosure, Help 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. 7 Tips for Seeking Second Opinions For Men with Prostate Cancer The site is secure. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. He was right. (I must say that those low numbers concern me a bit.) lesion. 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. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. * PIRADS v2 Score: 3 BONES: No suspicious osseous Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. Second Opinion Pathology | MD Anderson Cancer Center This is why the prostate is important to the body. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. Using the Bullet Volume gives you gland of 25.55. Unfortunately, monetary incentives create biases that can work against patients best interests. Atrophy Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. But I did speak to an oncologist who wanted to order Oncotype, which I did. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. 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. This is a PI-RADS 5 lesion in Asking for your comments: Then about a month later I started 28 fractions of Proton Radiation.It was painless. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. Johns Hopkins Hospital Prostate Cancer - ProstateProHelp.com My diagnosis is T2c, Gleason 7 (3+4). B. Prostate, right mid, core biopsy: 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. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. Bladder: Normal. I'm 58 yrs old and had a TRUS random biopsy October 2020 after my PSA continually stayed between 4.4 and 8, and PHI score was 126. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. In other words, the cancer is still contained within the prostate. Instructions for Second Opinion on Pathology (Gleason score) Does this also include HIFU, Cryoablation? Given that some 3+4 is now evident, I can no longer say that all my PCa is all 3+3 and that I can stay on AS for an extended period. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. Urology. Contact us or find a patient care location. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm An accurate diagnosis is essential to ensure the most effective treatment. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) 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. Benign prostatic tissue 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. I have searched the country for intervential radiologist that perform FLA on the prostate. You're also at greater risk of prostate cancer forming before age 50. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. 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. Hello. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. The average age at the time of prostate cancer diagnosis is about 66. Assessment categories for this lesion: For cancers that are less common, second opinions can offer more treatment options. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. All views would be appreciated. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. 3. We will then prepare a written recommendation regarding your treatment plans or options. 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. Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine Methods: Men need to be educated on all treatment options to protect themselves from a biased industry. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. * Seminal vesicle invasion: None. Prostate Cancer News, Reviews & Views: Second opinions decision on a single medical opinion or the first appointment you get, you may 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.). Even at the age of 48, he thought I would be a good candidate for AS. I say bullshit to them. Not all cancers are the same and not all treatment plans are absolutely clear. 1. That is literally the first time I heard that term other than seeing it in my pathology report. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. It hasn't let me down. Im immediately referred to Urologist. According to The National Institute on Aging, prostate problems are common after age 50. In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. Prostate, right medial base: I have a history where Foley catheters were unable to be placed going back to 2005 for unknown reasons. -------------------------------------------------------- Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. I had my first of those 2 PSA tests last week and it dropped to 4.77. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. FYI-We are also considering the trial at Princess Margaret Hospital in Toronto. Left mid-base transition zone (PIRADS 5). Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. National Library of Medicine Prostate Cancer | Johns Hopkins Medicine Second Opinions for Cancer Care - UChicago Medicine 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. A. Prostate, right base, core biopsy: This is the most common urinary tract problem in men under 50, and the third most common in men over 65. 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. Conflicting Prostate Biopsy OpinionsWhat to Do? Am I missing anything? John. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. present in bladder. 7. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. 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. Emotional outlook is fragile at times and straight clinical approach of doctors does not help. 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. 8: Prostate, left lateral base - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. There is hope. OTHER: None. I officially joined the club with diagnosis on March 21: three small lesions with a GS 6 on one side and both a GS 6 and a GS (3+4) 7 on the other side. Have you heard of PRECISE follow up score for an MRI? So, Radiation Oncologist prescribed Cialis 5mg, daily. 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. Most choose treatment they originally planned to follow, study finds. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. One to a 3+4=7 and the other to a 3+3=6. We are vaccinating all eligible patients. 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. Younger men also sought the 'best' doctor. 1. 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. By seeking second opinions and hearing the benefits and drawbacks of a range of treatment options for your specific stage, you will be more equipped to make educated decisions. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins.