My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. My strong preference would be to do FLA again and monitor. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? Secondary Gleason grade: 4 This is often the case when the primary physician advises an expensive treatment. Ozzieville (Michael), Hello All and thanks for being here~This is my first post.My husband was diagnosed with PC (adenocarcinoma with Extensive Intraductal Carcinoma Present) a few weeks ago. 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. He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms. This condition causes pain in the lower back and groin area, and may cause urinary retention. As some of you may know, I am a moderator for a support group for men on active surveillance for low-risk prostate cancer. 3 months has passed, and its time for a PSA and a plan to have an MRI. I met with the radiologist 3/17 and he leans toward an IMRT radiation regimen of 5 or 20 sessions TBD combined with ADT (6-month shot but maybe 4 months was enough). * PIRADS v2 Score: 3 For a second opinion on the results of your prostate biopsy, there is no place better to get one than from the well known prostate pathologist, Dr. Jonathan Epstein at Johns Hopkins. Before Radhakrishnan A, Grande D, Mitra N, Pollack CE. Some pathologists have more experience than others. I didn't study for the test and it's possible some morning activities might have affected my test score :) - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) Below is the link with instructions and the authorization form for you to use with your doctor. 2021 Sep 24;11(9):e044033. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. 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. Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of Other Features: 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. 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. 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. I had a follow up 3T MRI guided biopsy on March 18 at Emory. Extracapsular extension: The prostatic capsule is preserved. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. Seeking a Second Opinion - American Cancer Society Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). Have you heard of PRECISE follow up score for an MRI? However, seeing him will be another 8 weeks, but he wants my biopsy slides (second opinion) before we meet. Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, John Hopkins Prostate Cancer Second Opinion, a higher risk of developing uterine cancer, surgery may not always be necessary for all breast cancer patients, The cancer vanished in every single participant, Long Term Side Effects Of Brachytherapy For Prostate Cancer, treat rare and complex conditions through breakthrough fetal procedures, Prostate Cancer External Beam Radiation Side Effects, Can Enlarged Prostate Cause Blood Clots In Urine, Life Expectancy Stage 4 Prostate Cancer No Treatment, Prostate Cancer Spread To Skull Prognosis, Diagnostic Procedures For Prostate Cancer. My other option for treatment is either LDR or HDR brachytherapy. I am unfortunately "officially" joining the club after getting my biopsy results today. Some specialists have more expertise and more experience than others. Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm Your email address will not be published. Prostate, right lateral base: The study was published online Nov. 7 in the journal Cancer. In 2006 my PSA was .6. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. He also said perinueral invasion, but not extracapsular extension. In fact, additional biopsies revealed no additional cancer. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Get a Second Opinion What can a second opinion tell me? I find that when I'm trapped in the cockpit not able to use the bathroom for a long time is when I experience that most. A enlarged prostate can also cause blockages in the urethra. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 1 of 2 cores (lateral core: 4 mm, 35%), 0.1 mm to the blue inked tissue edge Some men have minimal or no symptoms at all. I'm turning 58 in one week. The percentage of tissue with carcinoma is 45% Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. In other words, can I have a team here in Wisconsin yet travel elsewhere to get my MRI? 4, Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Know Your Stage. Note respondents were able to choose more than one reason. I assume it is not free. Move ahead to Dec 2020. Are considering a treatment that involves significant risks, such as surgery. 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. HHS Vulnerability Disclosure, Help You May Like: Best Treatment For Intermediate Prostate Cancer. I would love to hear from anyone who has been involved in the Chicago study. Seminal vesicles are normal. I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. 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. Find more COVID-19 testing locations on Maryland.gov. I followed up with the original pathologist to compare and he was more forthcoming. ADC: mean 879 / median 839 / st dev 223 You may be concerned that the cancer will grow rapidly out of control before you are able to get a second opinion. John. Benign Processes: Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC However, before getting a second opinion, its best to check with your insurance company to see if there are any limitations in coverage. Send a Consult for Second Opinion | Johns Hopkins Pathology * Location: Right, anterior, apex, peripheral zone Interesting differences: As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Masks are required inside all of our care facilities. Seek Perspective from a Range of Specialists. In severe cases, a catheter may be required to relieve the symptoms. MY THOUGHTS AND ANYTHING DOCTOR NOTED: After a little experimenting I have been able to achieve a partial erection. 1: Prostate, right lateral apex Prostate dimensions: 4.1 x 2.8 x 3.4 cm Contact us or find a patient care location. Benign prostatic tissue Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. - T2 = 3/5 The treatment of prostate cancer has evolved tremendously. Disclaimer. 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. Am I wrong? This teamwork ensures the best possible patient outcomes. It works. When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. Luckily, his report co-coincided with the original QDx report. As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. Specimens Submitted: Grade Group: 2 My questions are: Sometimes, you may find out about treatment options you didnt know were available. 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. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. ZERO - The End of Prostate Cancer Support Community. That is literally the first time I heard that term other than seeing it in my pathology report. I am also talking with Dr Nour and Dr. Walser and possibly others to see if I am a good candidate for Focal Laser Ablation. It would be more convenient to use Mayo but I want the best practitioner regardless. Prostate cancer is the second-most diagnosed cancer in American men. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. -------------------------------------------------------- * Size: 1.5 cm Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . doi: 10.1136/bmjopen-2020-044033. They basically said it didn't matter. I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. Is it done through my doctor or do I do it myself with sending CDs of the MRI? 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. 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. The James Buchanan Brady Urological Institute, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Precision Medicine Center of Excellence for Prostate Cancer, robotic-assisted radical laparoscopic prostatectomies, The Brady Urological Institute and the Johns Hopkins Kimmel Cancer Center take a, Our urologic surgeons have extensive experience performing, Our surgeons, oncologists and radiologists are also world leaders in prostate cancer research, giving patients access to the latest discoveries and. At the Johns Hopkins Medical Institutions, he is Professor of Pathology, Urology, and Oncology the recipient of the Reinhard Chair of Urological Pathology and Director of Surgical Pathology. G. Prostate, lesion #1, core biopsy: There is no bony or bulky nodal disease in the pelvis 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. A second opinion can help you make an informed, confident decision about your medical care. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. I just turned 71 in February. 2. 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! intricate disease and not all doctors have the same amount of experience This is why the prostate is important to the body. The site is secure. The linear amount of tissue with carcinoma is 23 mm Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. 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." Prostate Cancer Grading: 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. Benign fibromuscular stroma; no prostatic glands are identified This shows very high signal intensity on the diffusion-weighted 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 is OK to be overwhelmed with info. 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. prostate cancer; quality of health care; second opinion; specialists; treatment. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. 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 soon as pathology slides were ready, Emory sent them to Dr. Epstein at Johns Hopkins. 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. 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. Second Opinion Pathology | MD Anderson Cancer Center Good Luck and God Bless everyone. About 60% of prostate cancers occur in people older than 65. 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 study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. We have a consult on Friday with the 1st opinion doc to review all tests. 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. 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). My urologist has decided we'll go ahead with the MRI due to the continued elevated PSA scores, in addition to the overall PHI score. 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. Now, I would like to send Radiology for a similar review. * Extracapsular extension: None. 5. 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. 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. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. We experienced information overload and decision/analysis paralysis. Patient-Driven Second Opinions in Oncology: A Systematic Review. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. So, I believe I made the right choice. I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. Surprisingly, while one in nine men will get diagnosed with prostate cancer in their lifetime1, there are very few doctors who specialize exclusively in treating prostate cancer. Metastatic disease considered less likely for this pattern. Second opinion Biopsy came after FLA G-9. Just had my appointment today and they are pleased with the results, so far. It is OK to be overwhelmed with info. 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. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. Am I missing anything? A. Prostate, right base, core biopsy: -------------------------------------------------------- Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. About this time, I started reading this forum and my ignorance starts going away. Their opinions are widely held to be definitive. 30%/40% or higher)? - Johns Hopkins Medicine -- Get a Second Opinion MRI June 2017 again at SMIL. And thanks again for making this such a great support group! I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. sharing sensitive information, make sure youre on a federal They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. In the mean time my PSA was movingno longer static, but never back up to 6. 4. Didn't know if she had the catheter in far enough and not getting any urine through itwondered if she had inflated the balloon enough and wondering if it was the reason that I have developed an abscess. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Diffuse probable benign peripheral zone changes limit evaluation for The out-of-pocket cost may be in the $300 range (insurance may not cover it), and it is a simple matter to call your urologist to forward the slides to them. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. You May Like: Prostate Radiation Treatment Side Effects. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. Thank you! Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. All views would be appreciated. MEASUREMENTS: On the first scan (post FLA) a lesion was identified by the local radiologist that performed the scan, but the FLA radiologist that performed my procedure was over reading and monitoring my care and stated strongly that there was no cancer. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. It was easy. My question is regarding the results of an MRI guided biopsy into a distinct tumor vs. subsequent Oncotype Dx 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. 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. We will give that a shot and see how it turns out. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): Maybe lycopene and pomegranate have helped. 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. Left mid-base transition zone (PIRADS 5). When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. I would appreciate hearing from that 2.8% out there who have an intraductal component. Negative cancer in lymph nodes, seminal vesicles, and all margins. Video consultation and written report from your expert. I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. 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. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. Benign Processes: Cancer. My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. 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. 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. They agreed with the PI-RADS 4. IMPRESSION: Symptoms include leaking and discomfort. You think your doctor is underestimating how serious your cancer is. 3. 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. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) 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. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. We specialize in minimally invasive procedures to treat BPH, including: For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success. (I must say that those low numbers concern me a bit.) probably organ confined disease. Comments appreciated, Masks are required inside all of our care facilities. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. -------------------------------------------------------- And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. Lesion 2: Right mid anterior transition zone. 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. Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. Epub 2017 Jun 12. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Targeted MR/Fusion biopsy of one 4x8 mm lesion on Right side showed 3+3 in 2 of 5 cores (20% of total volume), and random Right side: 1 core 3+4 (10%, 20% on second opinion from Johns Hopkins) and 1 core 3+3 (10% volume) ; Left Side 1 core 3+3 (10%, no PCa on second opinion from Johns Hopkins). Future study is needed to determine when second opinions contribute to increasing the value of cancer care.

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