johns hopkins prostate cancer second opinion johns hopkins prostate cancer second opinion

He also said I would tolerate any option well based on my age and health. Enter the last name, specialty or keyword for your search below. World J Urol. The average age at the time of prostate cancer diagnosis is about 66. * Seminal vesicle invasion: None. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. Maybe lycopene and pomegranate have helped. government site. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. 5: Prostate, left medial apex Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. This has raised some questions on all the scans so far. Reinterpretation of imaging scans and lab tests. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. Unauthorized use of these marks is strictly prohibited. You're also at greater risk of prostate cancer forming before age 50. 3. 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. When first diagnosed with prostate cancer, your PCP will generally refer you to a urologist for a biopsy. I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. 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. Get a Second Opinion Then about a month later I started 28 fractions of Proton Radiation.It was painless. Medical record collection from doctors and hospitals. About 60% of prostate cancers occur in people older than 65. 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. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Treatment options include immunotherapy, But I did speak to an oncologist who wanted to order Oncotype, which I did. Unfortunately, monetary incentives create biases that can work against patients best interests. Benign Processes: fibromuscular stroma, anterior prostatic contour is smooth. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. 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. Greatest dimension 0.7cm . My Oncotype rating was GPS 54, with a 26% chance of metastisis within 10 years. Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Read Also: Nhs Prostate Cancer Risk Calculator. An acute bacterial infection can cause a burning sensation. Potentially inaccurate results can lead to selection of the wrong type of therapy. Bladder: Normal. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. 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. 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. Everything seems to be on track to remove the cancer and be cured! information. THANKS! Patients may experience a fever or chills as a result of the infection. This championship swimmer sought a second opinion at Johns Hopkins. Make an appointment: 410-955-5222 Coordinating with your Treating Physician At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. Second opinions apply to biopsies and imaging as well. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. This kills both birds with a single stone. 3. (I must say that those low numbers concern me a bit.) What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Thanks for considering. 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. They won't be offended, and they may even be able to recommend a specialist for you to see. 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 appreciate any comments or insight that anyone wants to share. They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. * Gleason Score: 4+5, Slide 4 (vs. Sloan's 3+4) 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. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. 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. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. 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. - T2 = 3/5 P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. I suggest for all that hear, "you have cancer" that you seek more opinions! Symptoms include leaking and discomfort. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. Either the patient or the primary physician can initiate the process of getting a second opinion. We are vaccinating all eligible patients. Especially opinions other than those of the first Urologist you see. Family history of prostate cancer. The best protection for cancer patients who are Health Maintenance Organization members is to seek a second opinion even if she or he has to pay for it. The more often a doctor diagnoses and treats prostate cancer the more proficient they become. )As for side effectsI occasionally have some urgency/hesitancy having to pee. The problem is that all 3 pathologies noted an intraductal component. Further, the two tumors in question have not really changed much in size for more than 2 years. Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. FLA DONE AT FIRST BIOPSY G- 7. Other Features: Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. My urologist suggested a couple more PSA tests followed by an MRI. Second opinions offer different things in different circumstances, Dr. Matasar says. MRI obtained outsideon 04/16/2021. U.S. News & World Report ranked the institute #7in the country. 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. transition zone. I say bullshit to them. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. We are vaccinating all eligible patients. This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues. Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. 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. Because I had an implant in my ear, they would only give me a 1.5T MRI. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Your doctor is not a specialist in your type of . Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? There is hope. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. First MRI done in June 2016 by Scottsdale Medical Imaging - nothing found. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) 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? This shows very high signal intensity on the diffusion-weighted No definitive evidence of distant metastatic disease is seen." 2. An accurate diagnosis is essential to ensure the most effective treatment. I retested in January 2019 and scored 4.20. 3/5 ---------------------------------------------------------- However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Comments appreciated, 9. The linear amount of tissue with carcinoma is 23 mm Prostate Cancer Grading: Greetings gentlemen! In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. 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. When I read the forums and questions on this site everyone mentions their Gleason Score from their biopsy. 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. - DWI-ADC = 4/5 MRI RE-READ #3 (National Cancer Center of Excellence): )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. 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. Find more COVID-19 testing locations on Maryland.gov. My question is--what importance do volume levels play in determining when to move from AS to treatment? Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. In severe cases, a catheter may be required to relieve the symptoms. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. 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. 2 cores from left base of 3+4=7 with only 5% involvement. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. Youve just been diagnosed with prostate cancer. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Seminal vesicles are normal. Therefore, the value of these second opinions remains unknown. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. 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. And it is OK to have paralysis by over-analysis. 8600 Rockville Pike 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 The peripheral zone has a patchy signal pattern. 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. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Oncologist. Consult Fees In some cases, additional testing may be required. 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. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. 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.). Here's what JH says (same lesion). It will be interesting to see, I think. Pingback: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Pingback: Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Your email address will not be published. You may choose to consider a second opinion if you: A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. FOIA There are also some cases of the test showing no depletion but being wrong. Does this also include HIFU, Cryoablation? Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. Benign fibromuscular stroma; no prostatic glands are identified Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. 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. As a result, patients struggle to differentiate bias from fact. 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. 3. PREVIOUS MRI RESULTS (LOTS of them) Masks are required inside all of our care facilities. That said, I have some questions that I derived, keeping in mind that 99% of what I have learned since February has come directly from this group: As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. A enlarged prostate can also cause blockages in the urethra. ZERO - The End of Prostate Cancer Support Community. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. J Am Board Fam Med. Find more COVID-19 testing locations on Maryland.gov. If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. * Adjacent organ invasion: None. John. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. IMPRESSION: 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. 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. C. Prostate, right apex, core biopsy: Based on the results, our experts can provide you with an individualized treatment plan before you leave. I guess TWO national centers of excellence are better than one? Fear, confusion and uncertainty set in. -------------------------------------------------------- Johns Hopkins is home to many of the world's leaders in Pathology. 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. To learn more about how to get a Neuropathology second opinion, please visit our Neuropathology Division second opinions website. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. Hello. PROSTATE LESIONS: So, I asked the Radiologist if she will schedule one for me. 5. Dr. Erick Walser at University of Texas Medical Center. I opted to waive the biopsy, wait 1 year and test again. There are lots of lessons learned on the forum. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Benign Processes: 2. The presence of any G4 has been my trigger to seek treatment. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. Diffusely decreased -------------------------------------------------------- A fusion biopsy was performed in late May and I just received those results last Thursday. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. Six weeks later I have the biopsy in his office and a week later I get the results. It hasn't let me down. Prostate cancer is the second-most diagnosed cancer in American men. So, I believe I made the right choice. poorly defined margins and intermediate to low T2. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. The primary goal is to be cured with the least toxic, most effective approach. Only took Motrin and Tylenol for pain after release. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) SO. * PIRADS v2 Score: 3 doi: 10.1002/cncr.30412. I followed up with the original pathologist to compare and he was more forthcoming. Not all cancers are the same and not all treatment plans are absolutely clear. Pathology reports are subjective. Other: There is trace ascites in the mesosigmoid. DIAGNOSIS: 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. I was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. I now have my list whittled down to 3. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken I've had what I would consider a fluctuating PSA since first tested in November 2018. Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . The total number of cores identified is 3 Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. Bookshelf Dr. Dan Sperling - New York. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Good Morning Brothers- Grade Group: 2 Have been told a health condition is not treatable. The lesion also shows focal increased permeability. I am 65 and in excellent general health. 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. 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. Consultation with your nurse care manager. 4. Johns Hopkins Health - Second Opinions, Second Chances, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, High Blood Pressure May Take Its Toll on Your Kidneys. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. 53 years old Call us with any questions: 410-955-2405, ext. Seek Perspective from a Range of Specialists. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. Be well. My prior Prolaris study (2018) before the FLA was very low risk. PELVIC LYMPH NODES: No adenopathy. Seminal vesicles and other margins are negative for tumor. 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. Just had my appointment today and they are pleased with the results, so far. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. 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. I really just want the results of their innovative PTEN test. Confirm biopsy and imaging results with centers of excellence before making any final decisions. It is OK to be overwhelmed with info. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. 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. Bring All Labs/Notes to Each Appointment. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. Y'all are in my prayers! I'm Gleason 3+4=7, and I believed only 2 cores tested positive. I would appreciate hearing from that 2.8% out there who have an intraductal component. 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. It was easy. * PIRADS v2 Score: 5 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. Prostate, right medial base: Question anemia. Benign prostatic tissue How long do you have left? The .gov means its official. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. When people recommend going to a Center of Excellence, believe them. If pain is present, a digital rectal examination will reveal hard areas. 5. A new study by researchers at the Johns Hopkins University has found that second opinions did not change treatment choice among men diagnosed with low-risk prostate cancer. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. After a little experimenting I have been able to achieve a partial erection.