The treatment of prostate cancer has evolved tremendously. It works. Have been told a health condition is not treatable. Unfortunately, monetary incentives create biases that can work against patients best interests. The reasons for opting for treatment: the single lesion - previously Gleason 3+4, with a small percentage of pattern 4 - has grown, and according to a biopsy performed March 25, my Gleason 3+4 is now a Gleason 4+3. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine Recently diagnosed a Gleason 3 + 3. I then had the PHI test which showed PSA 8.70 and overall PHI 125.9. I assume it is not free. doi: 10.1001/jamanetworkopen.2020.28320. 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. 3. 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. I just turned 71 in February. You're also at greater risk of prostate cancer forming before age 50. 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. 10. Any input on this would really be appreciated. If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results. Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. Some men may have an enlarged prostate but not notice it. The prostates function is to create some of the fluid that insulates sperm cells found in semen. Benign Processes: Day 7 after surgery I took my last pain pill. 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. Note respondents were able to choose more than one reason. If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. of tumor in the rectal prostatic angles. Us Too Prostate is a great club and many of you have helped me a lot already. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Five years ago I had a TURP. 4. Do I need a third opinion? 7. Immediate means 6 weeks just to see his NP. This puts PCPs in a unique position to impact the treatment decisionif they only refer to urologists and not to radiation oncologists or medical oncologistssurgery is a likely treatment outcome. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. 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.). At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). 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. According to The National Institute on Aging, prostate problems are common after age 50. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . After a little experimenting I have been able to achieve a partial erection. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Find more COVID-19 testing locations on Maryland.gov. Where to start for newly diagnosed advance prostate cancer I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. You May Like: Sbrt Radiation Therapy Prostate Cancer. In terms of cancer, changes can be from cancer to benign (or vice versa) or from one type of cancer to another, which could have a significant impact on treatment and prognosis. International Patients: How to Request a Remote Second Opinion 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. During puberty, the body produces semen in a large number of cases, including enlarged prostate. 3. Netto says patients should be proactive in requesting that doctors take another look. Avoiding obsolescence in advanced prostate cancer management: a guide for urologists. peripheral zone signal intensity on T2-weighted images. Hope to hear from a bunch of people. MRI RE-READ #3 (National Cancer Center of Excellence): 2. Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. Also indicated everything else was "organ confined." Metastatic disease considered less likely for this pattern. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Treatment must be chosen based on stage and your 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. Second opinions not likely to change prostate cancer treatment Proton Therapy Case Study - Prostate Cancer - Johns Hopkins Medicine Accessibility The lesion also shows focal increased permeability. How could this compare using only partial slide re-reading? My involvement is below maximum of 15% of core. If they do not cover this cost and you must pay out of pocket, keep in mind that a second opinion could save you from having to pay (financially and physically) for additional treatment down the line. You think your doctor is underestimating how serious your cancer is. Clipboard, Search History, and several other advanced features are temporarily unavailable. It is best to begin by talking with the doctor who made your initial prostate cancer diagnosis. Last year, Epstein's lab reviewed the pathology reports of 30,000 cases in which patients requested second opinions. Reasons for obtaining a second opinion from urologists. Spent the night in hospital with very little pain after the first couple of hrs. I made the appointments. Results: 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. Radhakrishnan A, Grande D, Mitra N, Pollack CE. They agreed with the PI-RADS 4. To learn more about how to get a Neuropathology second opinion, please visit our Neuropathology Division second opinions website. 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. Hoping that after I go through this that my advice to others will be able to guide them and that they can learn from my experience, as I feel I am gaining a solid foundation from both a practical and mental standpoint. Epub 2010 Oct 20. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. -------------------------------------------------------- He said that he saw what JHs was referring to but did not determine EPE for a variety of reasons. Patients may experience a fever or chills as a result of the infection. 1. 7 Tips for Seeking Second Opinions For Men with Prostate Cancer Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. Four had 60-70%, five have between 5-10%. Video consultation and written report from your expert. Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. A blocked urethra can also damage the kidneys. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Am I wrong? In severe cases, a catheter may be required to relieve the symptoms. Then about a month later I started 28 fractions of Proton Radiation.It was painless. 3. * PIRADS v2 Score: 5 2nd opinion"Sclerotic change at the right pubic bone with max SUV of 1.4." Some specialists have more expertise and more experience than others. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. 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. However, there were no other suspicious areas on MRI. 2 cores from left base of 3+4=7 with only 5% involvement. The people were great. Anyone else encounter something like this? Also, if any of you have a way to get medicare to pay some portion of the cost, please let me know as well. In some situations, insurers will even insist on a second opinion. Here are seven tips for seeking second opinions for prostate cancer: Before getting a second opinion, its important to know your stage of prostate cancer. EVERY DAY, they'd take a low dose X-RAY and low dose CT to align the fiducials and ensure my bladder was full and the bowel was empty. Prostatic Adenocarcinoma If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. Prostate volume: 17.58 cc Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." )As for side effectsI occasionally have some urgency/hesitancy having to pee. Breast Cancer: When to Get a Second Opinion - WebMD 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. 180 days after treatment PSA was .50. Those readings were reported on a second opinion by Dr. Epstein. prostate volume). This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Second opinions from urologists for prostate cancer: Who gets - PubMed Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. My only concerned was heavy metal poisoning and didn't know how long AS would be beneficial since I was starting at a young age. I worked out every day and it wasn't until the last week did I feel a bit fatiguedand experience a bit of urgency and hesitation having to peeflowmax fixed that right up!90 days after treatment my PSA came in at .56. When to move from Active Surveillance to Treatment for Prostate Cancer? Men with a college education or beyond also were more likely to cite wanting more information about their cancer as a motivation for a second opinion . Benign Processes: I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. Is there such a thing as having a team that isnt equipped with the best equipment nor the most experienced radiologists? PSA had increased to 5.4. Therefore, the value of these second opinions remains unknown. Your doctor is not a specialist in your type of . Epstein, who views about 12,000 slides a year, called for calm in my case and suggested another biopsy in six months. It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. The purpose of starting this discussion is to gather peoples thoughts and opinions and actual experiences with Prostate Focal Laser Ablation. This is why the prostate is important to the body. Thank you for your understanding and cooperation. 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. Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Hillen MA, Medendorp NM, Daams JG, Smets EMA. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. Jonathan Epstein, M.D. I'm going to reach out to UCLA to see what they can do. The urologist offered surgery and radiation as options on 3/10 when we met. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. And thanks again for making this such a great support group! I guess TWO national centers of excellence are better than one? Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. When facing an intricate disease like prostate cancer, the above scenario is far too simple to have a promising outcome. He wants me to begin the ADT around 5/1. He is the past president of the International Society of Urological Pathology. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. We are vaccinating all eligible patients. information. And it is OK to have paralysis by over-analysis. Prostate dimensions: 4.1 x 2.8 x 3.4 cm Pathology reports are subjective. Slightly Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. 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. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. And just this week, 1 YEAR post treatment, it is .46. Jonathan Epstein, MD received his doctorate from Boston University. 2. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. Nov 7, 2016. We will give that a shot and see how it turns out. 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. If anyone has used him, please let me know what your experience was like. Be sure to ask about and research the skills and experience a doctor has with treating prostate cancer. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? SO. 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. Based on the results, our experts can provide you with an individualized treatment plan before you leave. As evidenced on this site, some studies indicate that GS 6 shouldn't even be classified as PCa and that it isn't aggressive. Im currently 67 years old. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. 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. 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. I just received a second opinion report from Johns Hopkins. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: Some pathologists have more experience than others. I luckily found this webpage and I started reading everything I could get my hands on. MY THOUGHTS AND ANYTHING DOCTOR NOTED: doi: 10.1136/bmjopen-2020-044033. Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach. To learn your stage of prostate cancer, take the staging quiz on keytopc.com. I certainly would - after all, there's a certain brotherhood bond here. Second Opinion Pathology | MD Anderson Cancer Center Younger men also sought the 'best' doctor. Surgery took about 3 hrs. It is OK to be overwhelmed with info. In the rare chance a baby needs highly specialized care, the team at Johns Hopkins is available to treat rare and complex conditions through breakthrough fetal procedures. The biopsy took 12 cores, two from each lesion area and 8 randomly. Overall, obtaining second opinions was not associated with changes in treatment choice or with improvements in how patients viewed their quality of cancer care. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? Hopkins states that the one positive core (10% G6) was visualized by the MRI, so I am hoping that this increases our chances of making it through the screening process. His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. A week later had catheter removed and had no bladder leakage problems. So I initially thought this makes me a good candidate for AS. I luckily found this webpage and I started reading everything I could get my hands on. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. Thankfully, prostate cancer is extremely slow growing. 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." Know Your Stage. My prior Prolaris study (2018) before the FLA was very low risk. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive Prostatic Adenocarcinoma Only took Motrin and Tylenol for pain after release. Thanks, Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. 7. P/ 310-827-7707 | F/ 310-574-4002 | [email protected]. * Gleason Score: 3+3 (2 of 6 specimens) G. Prostate, lesion #1, core biopsy: * Location: Right, anterior, apex, peripheral zone Greetings gentlemen! Below is the link with instructions and the authorization form for you to use with your doctor. (I think that it was easier to see because Mayo's MRI technology and procedures are better than SMIL's.) Luckily, his report co-coincided with the original QDx report. Benign Processes: About this time, I started reading this forum and my ignorance starts going away. In the United States, prostate cancer is among the most common cancers found in men. The percentage of tissue with carcinoma is 45% Not all cancers are the same and not all treatment plans are absolutely clear. - DCE = (+) 2. Either the patient or the primary physician can initiate the process of getting a second opinion. A new study by researchers at the Johns Hopkins University has found that . Anyway, would appreciate knowing how to contact Johns Hopkins. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. 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. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. The results were ambiguous. 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. 3: Prostate, right medial apex MRI obtained outsideon 04/16/2021. You May Like: Prostate Cancer External Beam Radiation Side Effects. Benign prostatic tissue I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. We provide second opinions on the full range of gynecologic cancers: Ovarian Uterine Cervical Vulvar Vaginal Fallopian tube Placental tumors Some peritoneal cancers Epub 2017 Jun 12. I now have my list whittled down to 3. E. Prostate, left mid, core biopsy: Over 80,000 specimen cases are seen at Johns Hopkins each year. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. NONE of the many radiation oncologists, surgeons or urologists I've spoken with in my journey have ever mentioned the term to me so I had to look it up. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. Other labs for second . If I am rested, I find that I am more ready than if I am not. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer. 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). What have your doctors told you? poorly defined margins and intermediate to low T2. So, I asked the Radiologist if she will schedule one for me. I appreciate any comments or insight that anyone wants to share. 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. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him.
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