There are so many different departments at Hopkins that I don't know the optimal department to contact. Dont Miss: Can Prostate Problems Cause Burning Urination, Why Prostate Cancer Survivor John Shearron Thinks Its Important To Do Your Research | PCRI, Prostate Cancer Pathology in 2021 | Jonathan Epstein, MD | PCRI 2021 Conference, Johns Hopkins Prostate Cancer Second Opinion, treat rare and complex conditions through breakthrough fetal procedures, Function Of The Prostate Gland And Seminal Vesicles, Best Treatment For Intermediate Prostate Cancer, How Old Can You Be To Get Prostate Cancer, New Treatments For Stage 4 Prostate Cancer, Prostate Radiation Treatment Side Effects, Can Prostate Problems Cause Burning Urination, Prostate Cancer Spread To Skull Prognosis, Life Expectancy Stage 4 Prostate Cancer No Treatment, Diagnostic Procedures For Prostate Cancer. 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. And if so, what does being accepted in a AS program look like, do I need to be present at their location? 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. But I've had trouble getting Dr. Chang's office to provide any patient referrals. (The pathology report from Cedars-Sinai kept my diagnosis at 3+4, but a second opinion at Johns Hopkins upgraded me to 4+3.) Race and ethnicity. I did ask some questions about the study, if anyone is interested. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. BMJ Open. 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. Had a little complication a day after release, excessive blood/clots in urine. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Comments appreciated, I am at that critical juncture in which I at least need to formalize a plan, select a doctor/facility to work with, and continue my testing to make sure I have what I think I have. After sending off all of our records, CD of MRI and path reports, my husband is booked for screening in December. - T2 = 3/5 Prostate, left anterior MRI lesion: ADC: mean 879 / median 839 / st dev 223 fibromuscular stroma, anterior prostatic contour is smooth. Then about a month later I started 28 fractions of Proton Radiation.It was painless. HHS Vulnerability Disclosure, Help There are also many reasons why you may want to seek another opinion during the course of your cancer care. C. Prostate, right apex, core biopsy: !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. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. The https:// ensures that you are connecting to the If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. A. Prostate, right base, core biopsy: (Recommended by my oncologist, Dr. Mark Scholz.) I wanted to keep my options open. Biopsy Results: What Do They Mean? - Prostate Cancer Foundation MEASUREMENTS: In My Opinion? Get A Second Opinion | ZERO Prostate Cancer How much is the fee for an opinion of my recent MRI? Perineural invasion is identified Read books and realize as soon as they are published, they are outdated. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Over 80,000 specimen cases are seen at Johns Hopkins each year. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. Surgeon wants next PSA in 3 months. Thanks, BigD. We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. One to a 3+4=7 and the other to a 3+3=6. Based on this forum, Im very lucky for this outcome. Hi All, 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. 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. PI-RADS v2 score: 5. It would be more convenient to use Mayo but I want the best practitioner regardless. 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). If the enlarged prostate is not completely removed, it will shrink. Nov 7, 2016. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. Lesion 2: Right mid anterior transition zone. No definitive evidence of distant metastatic disease is seen." 3 months has passed, and its time for a PSA and a plan to have an MRI. 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. I just turned 71 in February. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. PSA: 4.7 ng/ml/PSA density: 0.27 ng/ml2 Total Gleason score: 7 In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. Most choose treatment they originally planned to follow, study finds. If I don't meter fluids before bed, I can expect to get up 3-4 times in the night. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. Seminal vesicles: The seminal vesicles are normal and symmetrical bilaterally. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. Include Your Primary Care Physician as Member of Your Treatment Team. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. 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. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. 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. As a Gleason 3 + 3, with 8 of 12 positive cores all with less than 30% cancer, and bilateral spread, I have determined that I cannot trust a blind biopsy in and of itself. So I initially thought this makes me a good candidate for AS. The biopsy took 12 cores, two from each lesion area and 8 randomly. Be sure to confirm your diagnosis at a center of excellence. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. The results were ambiguous. 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. Expert review of your case by a Cleveland Clinic specialist. And should I treat prostatitis before FLA? Negative cancer in lymph nodes, seminal vesicles, and all margins. Also, a second opinion provides the opportunity to get information from someone other than the physician who will be directing treatment, which is usually the main source of information for most patients. Same with the amount of how much pattern 4. Transition Zone: In the left base, mid and apical transition zone there is a large mass measuring 2 cm in size which has MRI June 2017 again at SMIL. Read books and realize as soon as they are published, they are outdated. 30%/40% or higher)? For these reasons, it is a good idea for HMO members to get a second opinion and make sure they are informed about clinical trials or other promising new treatments. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. Doctors can review their peers treatment suggestions and explain why they agree or disagree. Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. I'm going to reach out to UCLA to see what they can do. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. JAMA Netw Open. Does this also include HIFU, Cryoablation? Reasons for obtaining a second opinion from urologists. 10. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). 7 in 10 PATIENTS WHO GET A SECOND OPINION AT CTCA CHOOSE TO TREAT WITH US Call now to find out why: 800.888.8888 Rosie P. Colorectal Cancer Extracapsular extension: The prostatic capsule is preserved. Other labs for second . This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. Did robotic radical prostatectomy 1/25/12. Tumor Quantifications: Benign Processes: very activerun/cycle 6 days a week Prostate Cancer Grading: Natural history of progression after PSA elevation following radical 5. Now Im still ignorant and dont really know a Gleason from a Duck, so when the Dr says your treatment is radiation or surgery Im devastated. Day 7 after surgery I took my last pain pill. 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. Your doctor is not sure what is wrong with you. * Prostate volume: 22 cc The Johns Hopkins Brady Urological Institute is known around the world for its expertise in diagnosing and treating urologic conditions. Who Should Request a Second Opinion? Rectal cancer.A small trial that saw 18 rectal cancer patients taking the same drug, dostarlimab, appears to have produced an astonishing result: The cancer vanished in every single participant. A second opinion is part of the education process that is critical for many cancer patients. The TRUS biopsy is behind me, the second opinion from Johns Hopkins is behind me, and its time for next steps. Even if I go the radiation route, should I try for Proton radiation or some other type? I had the MRI in April 2021 and it showed a PI-RADS 4 lesion. 3. MRI RE-READ #2 (VERY VERY well respected radiologist): Required fields are marked *, PHONE 310-827-7707 I would love to hear from anyone who has been involved in the Chicago study. 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. While I now concluded we need to find "it", I researched the best approach to see what is really going on and to do this safely. SO. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. Abstract Context: In men who develop an elevated serum prostate-specific antigen level (PSA) after having undergone a radical prostatectomy, the natural history of progression to distant metastases and death due to prostate cancer is unknown. Now its easier than ever to get the answers you need and peace of mind you deserve. 5. The percentage of tissue with carcinoma is 70% 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. Value of Second Opinion in Prostate Cancer Uncertain, Says Hopkins Study. I still have some urgency and frequency issues, but I am not complaining too bad. J Am Board Fam Med. Enter the last name, specialty or keyword for your search below. I question the potential EPE and he said it didn't matter, but went ahead and ordered Oncotype. I suggest for all that hear, "you have cancer" that you seek more opinions! 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. FOIA Depending on your location, you may be able to have a telemedicine consultation. Dont Miss: New Treatments For Stage 4 Prostate Cancer. Spent the night in hospital with very little pain after the first couple of hrs. Metastatic disease considered less likely for this pattern. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. Hope to hear from a bunch of people. present in bladder. Expert review of your case by a Cleveland Clinic specialist. I did genetic testing and there were no mutations of concern, and everyone agreed that there probably wasn't "enough meat on the bone" to get a good genomic test from the biopsy.After seeing Dr Joe Busch, he said he didn't see any target lesions (PIRADS2), nor did he think I was in any danger. All Gleason 6 (3+3). * Perineural Invasion also detected 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. Unauthorized use of these marks is strictly prohibited. The total number of cores with carcinoma is 3 Many thanks for that. Maybe lycopene and pomegranate have helped. Benign prostatic tissue Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine I've been on AS for two years after my initial TRUS biopsy showed 3 cores 3+3 (10% volume) on Right side, and 2 cores 3+3 on Left side. I have actually had a second opinion a while back from Dr. Bush. No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." In severe cases, a catheter may be required to relieve the symptoms. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 5%) involving 2 of 2 cores (medial core: 3.5 mm, 30%; lateral core: 2.5 mm, 20%), 0.5 mm to the blue inked tissue edge (the closer) For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. Prostate cancer is a slow growing condition. 1. 1. Prostate cancer is an Over kill and redundancy I know, but it's my money, my prerogative. This may cause a conflict of interest between the patient and the HMO, especially if very expensive treatment is only available outside the HMO system. SMIL radiologist reported nothing found. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. Have been diagnosed with a serious or rare health condition. Some men have minimal or no symptoms at all. Second opinions offer different things in different circumstances, Dr. Matasar says. When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. Younger men were more likely to cite wanting more information about their cancer and to see the best doctor as the reason to seek a second opinion . Patients may experience a fever or chills as a result of the infection. I tried to send the samples out for genetic testing to Prolaris and Decipher, but there was an ordering error and they never went thru. 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. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. Benign Processes: Are there urologists out there that don't routinely order the DX test to get a better idea of low and intermediate risk cancers? have no symptoms, and yet you have cancer? * Prostate size: 3.9 x 2.8 x 3. cm Prostate, right lateral base: My other option for treatment is either LDR or HDR brachytherapy. Your email address will not be published. For all other cancer appointments, please call: 1-855-702-8222. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. Especially opinions other than those of the first Urologist you see. 4. Allow yourself the time to seek multiple opinions. This teamwork ensures the best possible patient outcomes. 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. It works. Finally, things are set and I know what is going to happen. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. 7. I can do radiation as a monotherapy. If they have an enlarged colon, their physician can perform a TURP procedure. T2W MRI score= 2, DW MRI score= 3, DCE MRI score=positive You May Like: Prostate Radiation Treatment Side Effects. Cancer 2017;123:1027-34. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. There is no extraprostatic extension. What have your doctors told you? 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 choose surgery over radiation because you can do surgery and then radiation, but it is almost impossible to do it the other way around. Y'all are in my prayers! 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. Seminal vesicles are normal. * Adjacent organ invasion: None. Adenocarcinoma: DRE is always normal. * He said probably not candidate for watchful waiting because of tumor volume shown and seen on MRI. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. Call us with any questions: 410-955-2405, ext. PROSTATE ADDITIONAL FINDINGS: Benign prostatic lesion. Only one core was diagnosed with a small amount of 3+3 (it was one of the three targeted cores). 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. A newly published paper by Fischer et al. My direct phone (mobile) number is 703-992-3662, or you can private message me via this platform. You May Like: Best Treatment For Intermediate Prostate Cancer. However, something is driving my PSA. Benign fibromuscular stroma; no prostatic glands are identified What are you doing about it? E. Prostate, left mid, core biopsy: Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. I opted to waive the biopsy, wait 1 year and test again. 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. Prostate Cancer | Johns Hopkins Medicine Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. As I said, I am 58, so I would really like to preserve my quality of life for as long as possible, but the genomics report has me concerned. My question is regarding the results of an MRI guided biopsy into a distinct tumor vs. subsequent Oncotype Dx Results. JHs just said it was minimal less than 5%. 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%).