I opted to waive the biopsy, wait 1 year and test again. After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. 2017 May-Jun;30(3):298-307. doi: 10.3122/jabfm.2017.03.160359. Treatment must be chosen based on stage and your By choosing the first doctor you speak with to be your treating physician, you may be putting your health in the hands of someone who lacks the expertise to accurately and safely treat your prostate cancer. Adenocarcinoma: You think your doctor is underestimating how serious your cancer is. DRE is always normal. Details are here: * Size: 1.5 cm An acute bacterial infection can cause a burning sensation. Using the Bullet Volume gives you gland of 25.55. I'm turning 58 in one week. The linear amount of tissue with carcinoma is 11 mm I am 65 and in excellent general health. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! -------------------------------------------------------- In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. Generally, the symptoms can stabilize over time. Cancer. The biopsy took 12 cores, two from each lesion area and 8 randomly. My biopsy report does not mention a GS and the second opinion from Johns Hopkins did not list a GS either. (Scores above 55 have a greater than 50% chance of finding clinically significant cancer on a biopsy) The biopsy showed 2 or 3 cores containing HG PIN but no cancer. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. If the enlarged prostate is not completely removed, it will shrink. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. * Perineural Invasion detected It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope! prostate cancer; quality of health care; second opinion; specialists; treatment. I can do radiation as a monotherapy. PELVIC LYMPH NODES: No adenopathy. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. The percentage of tissue with carcinoma is 70% Medical record collection from doctors and hospitals. My other option for treatment is either LDR or HDR brachytherapy. Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Then about a month later I started 28 fractions of Proton Radiation.It was painless. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). - Benign prostatic tissue The total number of cores with carcinoma is 3 It took me awhile but minutes ago received my second opinion from Johns Hopkins. I suggest for all that hear, "you have cancer" that you seek more opinions! Confounding this, I have read that the different genomic tests can disagree with each other, and that Oncotype is usually a more aggressive finding. However, learning more about prostate cancer and prostate-related health issues can help optimize health. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. You can find out by reviewing your plan or by reaching out to your insurance company. lesion. Epub 2010 Oct 20. Second opinions offer different things in different circumstances, Dr. Matasar says. It would be more convenient to use Mayo but I want the best practitioner regardless. There is no bony or bulky nodal disease in the pelvis Just had my appointment today and they are pleased with the results, so far. The linear amount of tissue with carcinoma is 23 mm 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. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. undefined will no longer be visible to you including posts, replies, and photos. 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. It starts many years ago. - Johns Hopkins Medicine -- Get a Second Opinion My plan is to choose quality of treatment over cost of the treatment. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. It has been 2.5 years and the PSA has still not doubled as well. By basing a treatment Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. ZERO - The End of Prostate Cancer Support Community. 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. 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. Other labs for second . 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. Confirm biopsy and imaging results with centers of excellence before making any final decisions. - 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 MRI RE-READ #3 (National Cancer Center of Excellence): Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. I am 58 and in very good health otherwise. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. This has raised some questions on all the scans so far. Abstract Context: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. Dont Miss: New Treatments For Stage 4 Prostate Cancer. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. But I refuse to sit still, I continue to research and to plan, as best I can. Potentially inaccurate results can lead to selection of the wrong type of therapy. We will give that a shot and see how it turns out. !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. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. They did 9 patients in Phase I and there have been 12 so far in Phase II. -------------------------------------------------------- Visit and Like ZERO - The End of Prostate Cancer on Facebook, Sign up to receive emails and news from ZERO - The End of Prostate Cancer, Search prostate cancer clinical trials and studies. In the United States, studies estimate 72 new cases of PN for every 100,000 people between the ages of 18 and 64 years old. What are your opinions of what that is, and where to get it? * Sloan only sent partial cores, slides 1 and 4. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. transition zone. 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. How important is Oncotype DX test for Gleason 7? doi: 10.1002/cncr.30412. Contact us or find a patient care location. - 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) The results were ambiguous. If they have an enlarged colon, their physician can perform a TURP procedure. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). So, Radiation Oncologist prescribed Cialis 5mg, daily. Lesions are all small or very small. 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. doi: 10.1002/cncr.30412. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. A few weeks later and just before my meeting with my new Johns Hopkins Dr I get the second opinion results from both biopsy and MRI. Dr. Nour is 100% sure that nothing has spread. Do I need a third opinion? About 60% of prostate cancers occur in people older than 65. This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. Accessibility Conflicting Prostate Biopsy OpinionsWhat to Do? Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 2. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. OTHER: None. My question is regarding the results of an MRI guided biopsy into a distinct tumor vs. subsequent Oncotype Dx Results. 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. He is the past president of the International Society of Urological Pathology. Y'all are in my prayers! 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 . Either the patient or the primary physician can initiate the process of getting a second opinion. The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. Greatest dimension 2cm. * Prostate volume: 22 cc The primary goal is to be cured with the least toxic, most effective approach. It's really that simple! We are vaccinating all eligible patients. 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 . - Perineural invasion is present If a targeted biopsy is planned, this lesion can be sampled at the same time. Unable to load your collection due to an error, Unable to load your delegates due to an error. They basically said it didn't matter. They are not objective. Got my physical and normal DRE with new Dr. No issues identified. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. 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. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. * Extracapsular extension: None. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. However, something is driving my PSA. PSA that brought me to this was 7.1. Epub 2017 Jun 12. Thanks, This kills both birds with a single stone. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. I still have some urgency and frequency issues, but I am not complaining too bad. My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. 24.5 BMI Seminal vesicles are normal. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS Negative cancer in lymph nodes, seminal vesicles, and all margins. Second opinion Biopsy came after FLA G-9. And it is OK to have paralysis by over-analysis. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 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. Sought Johns Hopkins second opinion of pathology slides. Read books and realize as soon as they are published, they are outdated. 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. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. Symptoms include leaking and discomfort. 2. National Library of Medicine My questions are: There is no one-size-fits-all treatment for prostate cancer. NONE of the many radiation oncologists, surgeons or urologists I've spoken with in my journey have ever mentioned the term to me so I had to look it up. You May Like: Sbrt Radiation Therapy Prostate Cancer. Prostate, right medial base: Discover what's to love about Charm City for yourself. * Adjacent organ invasion: None. 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. 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. Then about a month later I started 28 fractions of Proton Radiation.It was painless. But I did speak to an oncologist who wanted to order Oncotype, which I did. Read Also: What Are The Signs Of Prostate Infection. Because every patient is different, there are several ways to approach prostate cancer treatment. 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. Benign Processes: Just took time off and then life happened.Thanks in advance for the insights. Prostate, right lateral apex: * Seminal vesicle invasion: None. It is OK to not understand all the terminology. There is no evidence * 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. The total number of cores with carcinoma is 3 Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. Wow, I sound like a snob now! They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. The biopsy took 3 samples from the targeted region plus 16 sextant. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Obviously the Covid 19 issue is playing a part in all of our decisions. 4. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. You're at greater risk if you're Black or of African ancestry. * Location: Right, anterior, apex, peripheral zone With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. I have actually had a second opinion a while back from Dr. Bush. Some pathologists have more experience than others. I am relatively new to this forum and trying to educate myself as to my best course of treatment. Please enable it to take advantage of the complete set of features! - High grade prostatic intraepithelial neoplasia (HGPIN) Thank you for your participation! MRI June 2017 again at SMIL. How could this compare using only partial slide re-reading? Men need to be educated on all treatment options to protect themselves from a biased industry. The total number of cores identified is 3 Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. - DCE = (+) Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) 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. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Im also wondering why no one has scheduled me for MRI to see what biopsy missed. My experience at Johns Hopkins was awesome. No definitive evidence of distant metastatic disease is seen." Video consultation and written report from your expert. I still have some urgency and frequency issues, but I am not complaining too bad. It works. I was referred to a urologist and tested again in April at 4.40. 8600 Rockville Pike Based on the results, our experts can provide you with an individualized treatment plan before you leave. 2020 Dec 1;3(12):e2028320. 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. What are you doing about it? Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required.