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I still have some urgency and frequency issues, but I am not complaining too bad. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) government site. 180 days after treatment PSA was .50. Interesting differences: Recovery from Prostate Cancer | Bills Story. Want confirmation about a diagnosis or treatment. Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. 4. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night.At this point, I am convinced I made the right treatment choiceOHFOR THOSE THAT DON'T KNOW, THE VA HAS MADE REPRODUCTIVE CANCERS A PRESUMPTIVE CONDITION FOR THOSE THAT SERVED IN MOST OF THE WAR ON TERROR LOCATIONS.Good luck fellas and my prayers are with all of you having to contend with this disease. Treatment options include immunotherapy, JHs just said it was minimal less than 5%. Bethesda, MD 20894, Web Policies And it is OK to have paralysis by over-analysis. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. 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. Men have plenty of time to seek multiple opinions and thoroughly research each option before making a decision. I'm trying to figure out why the PSA keeps rising. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. I will say, the people I dealt with at Johns Hopkins were extremely nice and professional. * Other 12 slides not sent I had FLA done after first biopsy which staged me at 3+4 = 7. Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. - PI-RADS for this lesion = 4/5 The side effects of the cut, radiate, hormone regime are unacceptable to me. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. 4. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. (PZ) - normal Younger men also sought the 'best' doctor. 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. A newly published paper by Fischer et al. Anyone else encounter something like this? I've tried to find out about Dr. Wong but there's very little info on him. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. 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. Because physicians may differ in their approach to treating breast cancer, its very important to check with a breast cancer expert to know youre receiving the best treatment for you. We are vaccinating all eligible patients. The total number of cores with carcinoma is 3 1. MRI RE-READ #3 (National Cancer Center of Excellence): Call us with any questions: 410-955-2405, ext. Prostate cancer is the second-most diagnosed cancer in American men. Even if I go the radiation route, should I try for Proton radiation or some other type? Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. 2. D. Prostate, left base, core biopsy: 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). Benign fibromuscular stroma; no prostatic glands are identified Especially opinions other than those of the first Urologist you see. 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. I luckily found this webpage and I started reading everything I could get my hands on. G. Prostate, lesion #1, core biopsy: The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. Cancer. 1st opinion. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Cancer. Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. DIAGNOSIS: You think your doctor is underestimating how serious your cancer is. Second opinion Johns Hopkins? - Prostate cancer "We were surprised by the relatively large percentage of men who obtain second opinions for their prostate cancer," said lead author Dr. Archana Radhakrishnan of Johns Hopkins University in . 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. Yet none of my doctors ever mentioned it! Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: But was able to walk right into the JH Urology clinic for immediate treatment (flushing of bladder cleared everything up). Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. Benign Processes: Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. 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. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. Bladder: Normal. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! -------------------------------------------------------- Grade Group: 2 Your doctor is not sure what is wrong with you. I trust the second opinion Dr. Bush gave. 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. Reinterpretation of imaging scans and lab tests. Second Opinion Pathology | MD Anderson Cancer Center I am already positively surprised that I am still alive 4.5 years after my diagnosis. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Caused me to bleed heavily. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Explore our state-of-the-art patient care facilities in the Sheikh Zayed Tower. Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) In some situations, insurers will even insist on a second opinion. Accessibility 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. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. Getting a second opinion from us is easy, convenient, and all done remotely. Can it be salvaged or are the risks of cancer too high? probably organ confined disease. John. 8. It is OK to be scared. 9. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. ---------------------------------------------------------- Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. Brief MRI history. The treatment of prostate cancer has evolved tremendously. Thankfully, prostate cancer is extremely slow growing. Many researchers believe PTEN present is a strong brake on Thank you! Thanks to all of you for sharing! - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. 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. Surabhi Dangi-Garimella, PhD. Have a condition that isnt improving or is getting worse, despite treatment. I really liked the new group I went to as they identified the lesion right away, unlike the radiologist who performed the first procedure, and they also have a urologist on staff as well monitoring everything. I opted to waive the biopsy, wait 1 year and test again. Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. Many health insurance companies will pay for a second opinion, especially if it is for a medically necessary treatment. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. First 6 week PSA is undetectable. One Johns Hopkins study showed that out of 14,000 men who had surgery and were found to have Gleason 6 cancer confined to the prostate, "zero of those 14,000 men had lymph node metastases. No extraprostatic extension. However, that information will still be included in details such as numbers of replies. My first PSA was 8.03. 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. PMC To schedule an in-person visit for a second opinion or to determine if a telemedicine consultation is possible, call: In addition to cancer, our urologic team provides second opinions regarding urinary stone disease, urinary tract reconstruction, incontinence, male infertility and sexual health, and many other urologic conditions or procedures. Depending on your location, you may be able to have a telemedicine consultation. Reasons for obtaining a second opinion from urologists. Radhakrishnan A, Grande D, Mitra N, Pollack CE. 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. 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. Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC -------------------------------------------------------- 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. His most-frequently cited first or last authored publications is Pathological and Clinical Findings to Predict Tumor Extent of Nonpalpable Prostate Cancer, published in JAMA, which established the criteria for active surveillance. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. The total number of cores identified is 3 After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. My PSA over time has been creeping up over time (1.8 - 5/16, 1.0 8/17, 2.68 8/18, 2.9 12/18, 3.28 2/19, 3.01 8/19, 3.65 2/20, 3.31 6/20, 3.88 12/20) but I was frankly a bit shocked when I received word that I have cancer. Anyway, I'm reaching out to this group to see if anyone would be willing to chat with me about their brachytherapy experience at UCLA (even to talk me out of it). While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Prostatic Adenocarcinoma About 60% of prostate cancers occur in people older than 65. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. Have you heard of PRECISE follow up score for an MRI? Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. intricate disease and not all doctors have the same amount of experience Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. After all, it seems like good idea to deal with your cancer sooner rather than later. 180 days after treatment PSA was .50. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. 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. Medical record collection from doctors and hospitals. I certainly would - after all, there's a certain brotherhood bond here. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Am I wrong? And just this week, 1 YEAR post treatment, it is .46. If the enlarged prostate is not completely removed, it will shrink. Second Opinions - Bladder Cancer | Johns Hopkins Pathology 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. 2 cores from left base of 3+4=7 with only 5% involvement. 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. Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. I had a very bad experience with an incompetent nurse that did a catheter change. Men were asked if they obtained a second opinion from a urologist, and the reasons why. 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. The problem is that all 3 pathologies noted an intraductal component. - 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) However, there were no other suspicious areas on MRI. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. doi: 10.1002/cncr.30412. Read books and realize as soon as they are published, they are outdated. Consultation with your nurse care manager. 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. If I am rested, I find that I am more ready than if I am not. Lesion 2: Right mid anterior transition zone. Second opinions from urologists for prostate cancer: Who gets - PubMed So the pathologist suggested a second opinion. He basically said it was possible, but that he did not agree. A second review of Pathology more frequently also brings changes to the cancer grade or stage, which can affect prognosis as well as therapy. I was offered to have my first biopsy sent to Johns Hopkins for second opinion and said why not? which came back with Gleason 9 three weeks after having the what we thought was G-7 ablated. IMPRESSION: 53 years old restricted diffusion. 2. Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. Have been told a health condition is not treatable. Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. 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. Right mid anterior transition zone (PIRADS 2). I just turned 71 in February. Getting a second opinion from Johns Hopkins, is it free or does one have to pay for it? He also said perinueral invasion, but not extracapsular extension. Greetings gentlemen! 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. I talked with Dr. Epstein who expressed Johns Hopkins' conservative views to not underestimate GS 6 and to consider surgery and/or radiation that have been used successfully for many years in saving lives. They did another 3T-MPMRI (Siemens machine) and it showed a faint area, near the margin, and very close to the down stream sphincter of prostate. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. You can find out by reviewing your plan or by reaching out to your insurance company. Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. 5. A biopsy was performed on 2/26. Cancer 2017;123:1027-34. Call us with any questions: 410-955-2405, ext. In other words, the cancer is still contained within the prostate. Benign fibromuscular stroma; no prostatic glands are identified Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. Dr. Dan Sperling - New York. There are also many reasons why you may want to seek another opinion during the course of your cancer care. 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. But you have to do both. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could . MY THOUGHTS AND ANYTHING DOCTOR NOTED: Unauthorized use of these marks is strictly prohibited. Fear, confusion and uncertainty set in. By taking the extra time to seek a second opinion, you have a better chance at finding the most up-to-date approach and an experienced doctor. Finally, things are set and I know what is going to happen. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. This doctor or team of doctors will review the following: The doctor then communicate their opinion regarding treatment to both the patient and the primary physician. In 2006 my PSA was .6. Prostate, right anterior MRI lesion: Prior to the results, the oncologist said that the literature shows that a 3+4=7 with less than 5% pattern 4 behaves just like a 3+3=6 and basically is an indolent tumor. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. I am 58 and in very good health otherwise. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. Their opinions are widely held to be definitive. * IF ANYONE reading this doesn't believe in the value of MRI first and targeted biopsy next then take note that my systematic biopsy cores showed 0 positive in 8 cores and my MRI guided core samples were 6 for 6 being positive! Now the oncologist wants to perform a PSMA Pet Scan. Do any of you have an opinion or actual experience with any of the three listed below? This is why the prostate is important to the body. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has Epub 2017 Jun 12. LESION 1 doi: 10.1136/bmjopen-2020-044033. I had a follow up 3T MRI guided biopsy on March 18 at Emory. 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%). 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. Know Your Stage. prostate cancer; quality of health care; second opinion; specialists; treatment. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. It hasn't let me down. The neurovascular bundles are intact. World J Urol. 30%/40% or higher)? Five years ago I had a TURP. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . !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. Please don't hesitate to make any observations or ask questions. Surgery took about 3 hrs. This has raised some questions on all the scans so far. * Adjacent organ invasion: None. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? Every year I got a PSA and DRE during my annual physical. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. 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. Our regional community network integrates academic specialty cancer care at Allegheny General Hospital and West Penn Hospital and at more than 20 community cancer centers throughout the region. Prostate, left medial apex: Seeking a Second Opinion - American Cancer Society - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length Thanks! 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. Two from one lesion were positive as was one of the two from the other. I really just want the results of their innovative PTEN test. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Masks are required inside all of our care facilities. Even at the age of 48, he thought I would be a good candidate for AS. Benign Processes: I'm leaning towards SBRT. Any input on this would really be appreciated. When to move from Active Surveillance to Treatment for Prostate Cancer? - Perineural invasion is present 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. Note respondents were able to choose more than one reason. * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project 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. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. The review process normally takes several days, after which we will send your slides and other materials are returned. The percentage of Gleason grade 4 and/or 5 is 5 % Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. 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. In My Opinion? Get A Second Opinion | ZERO Prostate Cancer __________________________________________________________________________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. Wow, I sound like a snob now! Methods: Receiving a second opinion was not associated with perceived quality of prostate cancer care. 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. SO. But I've had trouble getting Dr. Chang's office to provide any patient referrals. - Benign prostatic tissue Second opinions not likely to change prostate cancer treatment Here are seven tips for seeking second opinions for prostate cancer: 1. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. And should I treat prostatitis before FLA? MRI June 2017 again at SMIL. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. 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 Also Check: Prostate Cancer Stage 7 Treatment. 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.