Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. You're more likely to develop prostate cancers that are more likely to spread. I choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. Noted that some don't even include on report and should be looked as something to note but not obsess about. You have a rare or unusual cancer. 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. Yet none of my doctors ever mentioned it! The more often a doctor diagnoses and treats prostate cancer the more proficient they become. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. The biopsy took 12 cores, two from each lesion area and 8 randomly. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. This has raised some questions on all the scans so far. Prostate dimensions: 4.1 x 2.8 x 3.4 cm A blocked urethra can also damage the kidneys. Even at the age of 48, he thought I would be a good candidate for AS. Call us with any questions: 410-955-2405, ext. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. This shows very high signal intensity on the diffusion-weighted Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic. I worked out every day. - Follow-Up Score (PRECISE) for this lesion = Stable MRI appearance: no new focal/diffuse lesions. Not all cancers are the same and not all treatment plans are absolutely clear. MRI June 2017 again at SMIL. Any input on this would really be appreciated. I appreciate all the input because I am a little overwhelmed and confused as to the best course of treatment. Jonathan Epstein, MD received his doctorate from Boston University. In some situations, insurers will even insist on a second opinion. 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. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. The total number of cores with carcinoma is 3 We are vaccinating all eligible patients. The prostates function is to create some of the fluid that insulates sperm cells found in semen. I appreciate any comments or insight that anyone wants to share. Had a little complication a day after release, excessive blood/clots in urine. 3. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Negative cancer in lymph nodes, seminal vesicles, and all margins. The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Unfortunately, what you do not realize may harm you! However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. I've been on AS since April 2016. Total Gleason score: 7 * Membranous urethral length: 1.2 cm Radhakrishnan A, Grande D, Mitra N, Pollack CE. Confirm biopsy and imaging results with centers of excellence before making any final decisions. Doctors can review their peers treatment suggestions and explain why they agree or disagree. The percentage of Gleason grade 4 and/or 5 is 5 % Hello. Prostate, left medial base: 2. Receiving a second opinion was not associated with perceived quality of prostate cancer care. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. Brachytherapy Experience with Dr. Albert Chang at UCLA? John. doi: 10.1001/jamanetworkopen.2020.28320. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. I retested in January 2019 and scored 4.20. There is no extraprostatic extension. prostate volume). Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Not all cancers are the same and not all treatment plans are absolutely clear. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. Some specialists have more expertise and more experience than others. Include Your Primary Care Physician as Member of Your Treatment Team. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. Am I wrong? the transition zone. 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. 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, Also Check: How Old Can You Be To Get Prostate Cancer. !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. Unfortunately, monetary incentives create biases that can work against patients best interests. My profession for forty years was health actuary consultant, so I have a pretty fair understanding of health data, outcomes, and risks. The neurovascular bundles are intact. Have been diagnosed with a serious or rare health condition. A enlarged prostate can also cause blockages in the urethra. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. It hasn't let me down. No extraprostatic extension. 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. 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! It was easy. Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. I guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? The local pathologist read the biopsy and said 3+4=7 10% pattern 4 for both lesions. As a result, patients struggle to differentiate bias from fact. No definitive evidence of distant metastatic disease is seen." I wish the VA would be more informative about this disease they owe it to our veterans. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. In order to receive appropriate treatment, patients must understand the treatment options that are available. Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Here are the details: I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. D. Prostate, left base, core biopsy: EDI am now 52 and not quite functioning like I did 4+ years ago. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. The presence of any G4 has been my trigger to seek treatment. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Benign prostatic tissue Total Gleason score: 6 * 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. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. The percentage of tissue with carcinoma is 70% Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancer, Schaufeld Program for Prostate Cancer in Black Men, Read about the latest prostate cancer discoveries by our world-renowned researchers, Learn more about prostate cancer in our health library, Watch: What to expect during your post-surgery hospital stay. Obviously the Covid 19 issue is playing a part in all of our decisions. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. The total number of cores identified is 3 It hasn't let me down. I had my first of those 2 PSA tests last week and it dropped to 4.77. 4. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. Ex-Uro wanted to do biopsies and keep doing them until we find "it", even though he didn't know the size of the prostate nor had he ruled out prostatitis. What are you doing about it? Good Luck and God Bless everyone. He said that it will improve in the future due to future improvements in the treatments. 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. Luckily, his report co-coincided with the original QDx report. 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. 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. I made the appointments. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. Maybe lycopene and pomegranate have helped. Either the patient or the primary physician can initiate the process of getting a second opinion. Dr. Nour is 100% sure that nothing has spread. It took me awhile but minutes ago received my second opinion from Johns Hopkins. So the pathologist suggested a second opinion. I have been drinking out of an information fire hose. T2W MRI score= 5, DW MRI score= 5, DCE MRI score=positive Following his residency in anatomic pathology at The Johns Hopkins Hospital in Baltimore, Maryland, and a fellowship in oncologic pathology at Memorial Sloan Kettering Cancer Center in New York., he then joined the staff at The Johns Hopkins Hospital and has been there his entire career. The biopsy disclosed I had some abnormal cells resembling cancer known as PINS, short for prostatic intraepithelial neoplasia. My long-term prognosis appears to be good with minimal side effects. 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. 3. Second opinions apply to biopsies and imaging as well. MRI obtained outsideon 04/16/2021. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. Intensity: min 148 / Max 459 My plan is to choose quality of treatment over cost of the treatment. government site. I am doing my own research, but I am curious as to thoughts of the best possible MRI to obtain to give me the best chance at finding something the needle biopsy didnt find. I am unfortunately "officially" joining the club after getting my biopsy results today. Do any of you have an opinion or actual experience with any of the three listed below? Grade Group: 2 Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. 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. The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. Find more COVID-19 testing locations on Maryland.gov. He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. I say bullshit to them. Everything seems to be on track to remove the cancer and be cured! Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. Epub 2017 Jun 12. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! I was referred to a urologist and tested again in April at 4.40. 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. I also had my PTEN test by META-MARK ( I don't have much to say about how I was treated by MM, but I won't be using their services again). Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. 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. Note that I'm trying to get a second opinion from Johns Hopkins but Mayo, where the biopsy was performed, appears incapable of processing my request. 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. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. This fee includes: Studies show the clinical and financial benefits of obtaining a pathology second opinion. A enlarged prostate can also cause blockages in the urethra. But you have to do both. Hi All, Johns Hopkins is home to many of the world's leaders in Pathology. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. I am 62 years old. Covid turned the 1 year into 16 months and PSA tested at 7.44 in August 2020, followed by another referral back to the urologist. 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. The side effects of the cut, radiate, hormone regime are unacceptable to me. * Gleason Score: 3+4 (4 of 6 specimens), 14 specimens taken Who Should Request a Second Opinion? There are also many reasons why you may want to seek another opinion during the course of your cancer care. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers I suggest for all that hear, "you have cancer" that you seek more opinions! 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. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. 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. IMPRESSION: The average age at the time of prostate cancer diagnosis is about 66. Cancer. 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. fibromuscular stroma, anterior prostatic contour is smooth. 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. A. Prostate, right base, core biopsy: After applying exclusion criteria, the final analytic cohort included 2365 respondents. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. You May Like: Prostate Radiation Treatment Side Effects. It starts many years ago. Prostate, left lateral base: At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). 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). Best wishes to all those whose concerns for the day are far more serious than mine. It is OK to not understand all the terminology. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. transition zone. Thank you! You May Like: Prostate Cancer External Beam Radiation Side Effects. very activerun/cycle 6 days a week Just took time off and then life happened.Thanks in advance for the insights. 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. Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). 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. That's the good news. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. Even if I go the radiation route, should I try for Proton radiation or some other type? I am also doing a vegan diet with additional complementary substances. Over 80,000 specimen cases are seen at Johns Hopkins each year. Find more COVID-19 testing locations on Maryland.gov. 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. The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." I have posted here before, now with an update. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Prostate cancer is the second-most diagnosed cancer in American men. However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Medical record collection from doctors and hospitals. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. My question is--what importance do volume levels play in determining when to move from AS to treatment? I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. MRI RE-READ #3 (National Cancer Center of Excellence): You think your doctor is underestimating how serious your cancer is. 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. poorly defined margins and intermediate to low T2. My goals are to control PCa, to minimize side effects, and to keep options open in the future. Based on this forum, Im very lucky for this outcome. We will give that a shot and see how it turns out. 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. HMOs usually try to diagnose and treat patients within their system because the more money the HMO spends on second opinions and treatment outside the HMO, the less money there is available for operation costs and profits. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. 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. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. Benign Processes: A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. LESION 2 A doctor may prescribe surgery or perform an endoscopic procedure. Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. 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. Also these lesions did not abut or touch the wall of the prostate. I requested a second opinion from Johns Hopkins and they found 1 lesion was 3+3=6 and the second lesion was 3+4 =7, with less than 5% pattern 4. Epub 2010 Oct 20. I was on active surveillance after a FLA procedure done in 2018. Two things you learn here is get a second opinion from Johns Hopkins on biopsy and get treated at Center of Excellence. If they have an enlarged colon, their physician can perform a TURP procedure. Receiving a second opinion was not associated with perceived quality of prostate cancer care. 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. 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.