It is OK to not understand all the terminology. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. 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? Treatment options include immunotherapy, 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. Diffusely decreased They did 9 patients in Phase I and there have been 12 so far in Phase II. 1. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. 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. A doctor may prescribe surgery or perform an endoscopic procedure. In severe cases, a catheter may be required to relieve the symptoms. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. )As for side effectsI occasionally have some urgency/hesitancy having to pee. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. 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. This is often the case when the primary physician advises an expensive treatment. 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. The side effects of the cut, radiate, hormone regime are unacceptable to me. Second opinions apply to biopsies and imaging as well. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. 2. 4. 1. 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. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. 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. And luckily I lived in Chattanooga and had mutual friends with Dr. Joe Busch (my Urologist never mentioned him, yet we could almost see his facility from the exam room in which he broke the news. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. 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. Benign Processes: A PSA test at time of biopsy revealed my PSA had risen to 6.5. In other words, the cancer is still contained within the prostate. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. Be sure to confirm your diagnosis at a center of excellence. - 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) Their opinions are widely held to be definitive. - Benign prostatic tissue John, I was diagnosed on 11 December, 2013. The peripheral zone has a patchy signal pattern. Symptoms include leaking and discomfort. 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. 30%/40% or higher)? - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. 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. doi: 10.1002/cncr.30412. * Perineural Invasion detected And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. -------------------------------------------------------- Watch: Are supplements good for prostate health? You're also at greater risk of prostate cancer forming before age 50. A enlarged prostate can also cause blockages in the urethra. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Sometimes, you may find out about treatment options you didnt know were available. See this image and copyright information in PMC. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. 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. 1st opinion"Note is made of sclerotic changes in the right pubic bone adjacent to the symphysis pubis having only low-level activity and this is thought to be more likely due to degenerative changes rather than bony metastasis." It starts many years ago. There are also many reasons why you may want to seek another opinion during the course of your cancer care. 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. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. Even at the age of 48, he thought I would be a good candidate for AS. It hasn't let me down. * Seminal vesicle invasion: None. 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. Benign prostatic tissue My plan is to choose quality of treatment over cost of the treatment. I suggest for all that hear, "you have cancer" that you seek more opinions! The issues in my prostate from the first procedure onward have all been in the same area and the rest of my prostate from the first biopsy and subsequent MRIs onward have never shown any indications of cancer in other areas. I have developed an "abscess" on my prostate. * Gleason Score: 3+3 (2 of 6 specimens) fibromuscular stroma, anterior prostatic contour is smooth. Good Morning Brothers- This kills both birds with a single stone. 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. Possible additional organ confined malignant lesion in right apex Experts believe that this study is the first in history to have achieved such results. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. We had the 3T MRI (no coil) and MRI guided biopsy at Sperling in NY, and then had a 2nd Opinion done by Johns Hopkins. 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. Second opinions offer different things in different circumstances, Dr. Matasar says. Over 80,000 specimen cases are seen at Johns Hopkins each year. * Size: 1.1 cm The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. Some specialists have more expertise and more experience than others. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. official website and that any information you provide is encrypted The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. I am unfortunately "officially" joining the club after getting my biopsy results today. I would love to hear from anyone who has been involved in the Chicago study. PSA that brought me to this was 7.1. This may include imaging, blood tests, prior treatment, and pathology reports. So, Radiation Oncologist prescribed Cialis 5mg, daily. Getting a second opinion from us is easy, convenient, and all done remotely. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. However, there were no other suspicious areas on MRI. It hasn't let me down. During puberty, the body produces semen in a large number of cases, including enlarged prostate. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". Masks are required inside all of our care facilities. Check Biopsy and Imaging Results for Accuracy. IMPRESSION: However, there are also many more options for treatment and these options are more complicated than in the past. Of course that was before I found this webpage and I really didn't know what 1 core of 18 samples showing 3+4=7 Gleason meant. 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. You think another treatment might be available. Surgery took about 3 hrs. -------------------------------------------------------- I retired as a Dentist at the VA and saw many veterans with a wide range of outcomes as most of them became 100% service connected when diagnosed with prostate Ca due to exposure to Agent Orange if they served in Vietnam. 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. - PI-RADS for this lesion = 4/5 We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers World J Urol. What have your doctors told you? 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. Cancer patients are encouraged to obtain second opinions before starting treatment. Younger men also sought the 'best' doctor. We experienced information overload and decision/analysis paralysis. My question is--what importance do volume levels play in determining when to move from AS to treatment? My goals are to control PCa, to minimize side effects, and to keep options open in the future. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 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. radiation, active surveillance, surgery, hormone therapy, and more. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. HHS Vulnerability Disclosure, Help Benign Processes: Prostate Cancer News, Reviews & Views: Second opinions 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 . Tumor Quantifications: Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. Benign prostatic tissue They agreed with the PI-RADS 4. We have sought a second opinion and all tests are being reviewed by that second team.My question has to do with the symphysis pubis. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has I had a follow up 3T MRI guided biopsy on March 18 at Emory. These results, if validated in other studies, justify additional investigation on how second opinions can contribute to increasing the value of cancer care, the authors concluded. Negative cancer in lymph nodes, seminal vesicles, and all margins. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Metastasis. 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. 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. desired outcome. I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. 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? Intensity: min 148 / Max 459 Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. 3. However, he also said it's treatable even at a 2cm size and the transition zone is a favorable spot. Details are here: Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. 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. I could not get a definitive answer from them on how much, how many cells, or any information. Prostate Cancer Grading: Adenocarcinoma: Ask your doctor for a copy of your complete medical record. Generally, the symptoms can stabilize over time. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) Benign Processes: If anyone has used him, please let me know what your experience was like. focal peripheral zone lesions. Because I had an implant in my ear, they would only give me a 1.5T MRI. 7 Tips for Seeking Second Opinions For Men with Prostate Cancer intricate disease and not all doctors have the same amount of experience information. Instead, I did my homework. At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. 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. 7: Prostate, left lateral apex 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 were asked if they obtained a second opinion from a urologist, and the reasons why. Overall PIRADS Score: 2/5 Two from one lesion were positive as was one of the two from the other. Primary Gleason grade: 3 Other Features: Bethesda, MD 20894, Web Policies 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. Hello everyone. Men need to be educated on all treatment options to protect themselves from a biased industry. He wants me to begin the ADT around 5/1. * PIRADS v2 Score: 3 In the mean time my PSA was movingno longer static, but never back up to 6. Therefore, the value of these second opinions remains unknown. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. 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. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. Asking about other experience with conflicting Prostate Biopsy Opinions. Associated fees may be incurred up to $1,800 in a minority of more complicated cases requiring special studies. Not all cancers are the same and not all treatment plans are absolutely clear. Slight BPH findings. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. You receive a secure, private online consultation without leaving home. So, Radiation Oncologist prescribed Cialis 5mg, daily. I appreciate any comments or insight that anyone wants to share. We will give that a shot and see how it turns out. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. I had my first of those 2 PSA tests last week and it dropped to 4.77. I have actually had a second opinion a while back from Dr. Bush. 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. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. Thanks, Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. Just got my pathology results. At this time, I am leaning towards Active Surveillance or FLA. AS would be my choice, except that a total of three lesions, on both sides of Peripheral Zone, makes this controversial. Seems like a simple request. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Now, I would like to send Radiology for a similar review. It's really that simple! 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. Yet none of my doctors ever mentioned it! MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): I would appreciate hearing from that 2.8% out there who have an intraductal component. Overall PIRADS Score: 5/5 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. However, that information will still be included in details such as numbers of replies. However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. LESION 1 However, learning more about prostate cancer and prostate-related health issues can help optimize health. For all other cancer appointments, please call: 1-855-702-8222. The prostates function is to create some of the fluid that insulates sperm cells found in semen. Thanks! 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. Unauthorized use of these marks is strictly prohibited. I am 62 years old. Studies show the clinical and financial benefits of obtaining a pathology second opinion. Natural history of progression after PSA elevation following radical A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. 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. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? The percentage of Gleason grade 4 and/or 5 is 5 % Video consultation and written report from your expert. Find more COVID-19 testing locations on Maryland.gov. Everything seems to be on track to remove the cancer and be cured! 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. 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. Some men have minimal or no symptoms at all. -------------------------------------------------------- You think your doctor is underestimating how serious your cancer is. The more accurate the information we have, the better our treatment decisions. There are also many reasons why you may want to seek another opinion during the course of your cancer care. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. Get a Urology Second Opinion | Johns Hopkins Brady - Hopkins Medicine Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. Find more COVID-19 testing locations on Maryland.gov. 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. A doctor may prescribe surgery or perform an endoscopic procedure. 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. - 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 I recently sent my Pathology Slides to Dr. Epstein for a Second Review. The problem is that all 3 pathologies noted an intraductal component. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. This teamwork ensures the best possible patient outcomes. 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. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. 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. She put me in the hospital. I'm going to reach out to UCLA to see what they can do. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. However, something is driving my PSA. 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. Expert review of your case by a Cleveland Clinic specialist. 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. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. It is OK to be scared. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. Receiving a second opinion was not associated with perceived quality of prostate cancer care. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. 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. 3T MRI with coil is done initially, along with a TRUS biopsy. and transmitted securely. (I must say that those low numbers concern me a bit.) A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. How important is Oncotype DX test for Gleason 7? __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. 2020 Jul 21;19(1):112. doi: 10.1186/s12904-020-00619-9. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. Types of questions that pathologists often address in our second opinions: A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. H. Prostate, lesion #2, core biopsy: In order to give treatment for each patient with utmost security we would like to announce that currently there will be no visitors allowed.Please note that only one attendant per in-patients is permitted.
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