johns hopkins prostate cancer second opinion
I suggest for all that hear, "you have cancer" that you seek more opinions! They hesitated calling it a TARGET LESION, but scored it PIRADS 4. More medical freakouts. I am also not comfortable making a decision based upon 1 genomics test, when my other prior test(s) disagrees and the gleason score disagrees. I luckily found this webpage and I started reading everything I could get my hands on. Unauthorized use of these marks is strictly prohibited. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. Request an Appointment 410-955-6100 Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. You may also complete an online appointment request form and we'll respond to schedule an appointment. Hello everyone. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. Call us with any questions: 410-955-2405, ext. 1. He said that JHs said that it was 2 cores, but it was actually a fragmented core, that the fat did not present on the right place on the slide, that prior FLA (partial hemi-ablation) could affect the results, the MRI did not support, etc. In severe cases, a catheter may be required to relieve the symptoms. I've had what I would consider a fluctuating PSA since first tested in November 2018. There is no bony or bulky nodal disease in the pelvis Conclusions: probably organ confined disease. What are you doing about it? PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. So the pathologist suggested a second opinion. Discover what's to love about Charm City for yourself. 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. I asked the urologist who did our Second Opinion at Johns Hopkins and although he thinks RP is the way to go (due to higher PSA of 10.18), he highly recommended Dr. Eggenger (Chicago). A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether. Would it be rational to stay on AS until biopsy results show a higher volume of PCa for sampled cores (i.e. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. Doctors are skilled at pitching the treatment they specialize in. 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. -------------------------------------------------------- of tumor in the rectal prostatic angles. Extraprostatic extension: negative Accessibility JHs just said it was minimal less than 5%. And just this week, 1 YEAR post treatment, it is .46. So off I went to see a community urologist who performed a needle biopsy in his office. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. 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. Does this also include HIFU, Cryoablation? Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. We will then prepare a written recommendation regarding your treatment plans or options. Clipboard, Search History, and several other advanced features are temporarily unavailable. * PIRADS v2 Score: 3 No extraprostatic extension. 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. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! A second opinion can accomplish a number of things. I am 65 and in excellent general health. Best practices dictate that you obtain a second confirmatory pathology evaluation. A new study by researchers at the Johns Hopkins University has found that . 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. Over 80,000 specimen cases are seen at Johns Hopkins each year. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. 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. 3T MRI with coil is done initially, along with a TRUS biopsy. Second opinions offer different things in different circumstances, Dr. Matasar says. 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 first PSA was 8.03. Surabhi Dangi-Garimella, PhD. No definitive evidence of distant metastatic disease is seen." I worked out every day. 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? There are also many reasons why you may want to seek another opinion during the course of your cancer care. Getting a second opinion can sometimes lead to a complete change in diagnosis (such as cancerous to benign or vice versa) in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. After much discussion we both agreed that surgery was my best option and that he would do it at the end of July. 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. 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. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. 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. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. No extraprostatic extension. There is no extraprostatic extension. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? However, learning more about prostate cancer and prostate-related health issues can help optimize health. Some men may have an enlarged prostate but not notice it. My thoughts focus on the fact that I have a disabled son who needs my care. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? I have been drinking out of an information fire hose. 2 cores from left base of 3+4=7 with only 5% involvement. If the enlarged prostate is not completely removed, it will shrink. Grade Group: 1 This is often the case when the primary physician advises an expensive treatment. Anything I am overlooking or need to add to my list of considerations? Note respondents were able to choose more than one reason. (PZ) - normal 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%). Background: Netto points to prostate cancer as an example: If your diagnosis changes from a higher grade to a lower grade cancer, it could mean having the option to avoid radical treatment.Seeking second opinions is becoming standard practice, and it is mandatory at Johns Hopkins. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. 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. Below is the link with instructions and the authorization form for you to use with your doctor. Prostate Cancer Grading: * Prostate volume: 22 cc With that alone, I would likely be a candidate for continued Active Surveillance. Second opinions apply to biopsies and imaging as well. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. MRI RE-READ #1 (well known radiologist, but free advice over phone, but no written report): There are also some cases of the test showing no depletion but being wrong. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. I didn't study for the test and it's possible some morning activities might have affected my test score :) My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. Consult Fees In some cases, additional testing may be required. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) ---------------------------------------------------- Seminal vesicles are normal. Medical record collection from doctors and hospitals. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Studies show the clinical and financial benefits of obtaining a pathology second opinion. Need guidance choosing from multiple treatment options. 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. They won't be offended, and they may even be able to recommend a specialist for you to see. My urologist suggested a couple more PSA tests followed by an MRI. I also sent my biopsy slides to Johns Hopkins for a second opinion (Epstein's read was 3+4, but with lower pattern 4 involvement than the local pathologist.). Some men may have an enlarged prostate but not notice it. I am 62 years old. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. But I refuse to sit still, I continue to research and to plan, as best I can. Prostate, right lateral base: Have you heard of PRECISE follow up score for an MRI? An acute bacterial infection can cause a burning sensation. 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. 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. So, I believe I made the right choice. Benign fibromuscular stroma; no prostatic glands are identified 5. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. A biopsy was performed on 2/26. Just got my pathology results. 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. 2nd opinionBone Scan:"Mild increased activity is seen in the right symphysis corresponding to the abnormalities on the prior PET/CT examination. About this time, I started reading this forum and my ignorance starts going away. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. An acute bacterial infection can cause a burning sensation. Notice of Privacy Practices(Patients & Health Plan Members). Expert review of your case by a Cleveland Clinic specialist. Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. Am I missing anything? 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. They agreed with the PI-RADS 4. Director of Surgical Pathology- Johns Hopkins, http://pathology.jhu.edu/department/services/secondopinion.cfm, The guy I used along with everyone else is Jonathan Epstein, M.D. His second opinion just came back. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. First 6 week PSA is undetectable. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. However, there were no other suspicious areas on MRI. Check Biopsy and Imaging Results for Accuracy. Also, in 2018 I had an exosome Dx test which scored 45.34, but I also retook that test this year and it went down to 30.79. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. The survey asked the men if they had opted for a second opinion from a urologist following their diagnosis of prostate cancer, and the reasons for the second opinion. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. 3. It can be caused by many factors, including infection and inflammation. Here are the details: 5: Prostate, left medial apex 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. All Gleason 6 (3+3). * PIRADS v2 Score: 5 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. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. Best wishes to all those whose concerns for the day are far more serious than mine. I had the slides reviewed at Johns Hopkins and 1 of the HG PIN cores was changed to suspicious for adenocarcinoma while another HG PIN core was changed to benign. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Benign prostatic tissue 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. I still have some urgency and frequency issues, but I am not complaining too bad. 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." 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. Has anyone sent Radiology (mpMRI) reports and images to Hopkins for Second Opinion Review? I had my first of those 2 PSA tests last week and it dropped to 4.77. Will these places of excellence consider me, or am I bound to my regular doctor for insurance purposes? Let me know what everyone thinks if you see anything interesting or of note here or just have some advice. This championship swimmer sought a second opinion at Johns Hopkins. MRI June 2017 again at SMIL. I hope my story helps anyone out there just starting the process. I would love to hear from anyone who has been involved in the Chicago study. The linear amount of tissue with carcinoma is 11 mm Lesion 1: Left mid-base transition zone. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Be sure to confirm your diagnosis at a center of excellence. We are vaccinating all eligible patients. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . 4. Your doctor is not sure what is wrong with you. Explore our state-of-the-art patient care facilities in the Sheikh Zayed Tower. Prostate cancer is the second-most diagnosed cancer in American men. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. FLA DONE AT FIRST BIOPSY G- 7. Based on the results, our experts can provide you with an individualized treatment plan before you leave. Heres What You Need to Know, Prostate Cancer Spotlights in 2020: A Year in Review, Find out about PSMA PET Imaging on Prostate Pros Podcast. 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.
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