How long do you have left? Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. Who should I contact at Johns Hopkins to get a second opinion on a biopsy? Benign Processes: Shore ND, Karsh L, Gomella LG, Keane TE, Concepcion RS, Crawford ED. Asking for your comments: At Another Johns Hopkins Member Hospital: Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, Prostate Cancer Treatment: What to Know About Active Surveillance. Request an Appointment 410-955-6100 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. 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. 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. Another DRE that results in identifying that my prostate is enlarged, but cant find and nodules. However, there are also many more options for treatment and these options are more complicated than in the past. Expert review of your case by a Cleveland Clinic specialist. It also rules out Brachytherapy. not hear all the viable treatment options or receive the most up to date There is no extraprostatic extension. Generally, the symptoms can stabilize over time. Move ahead to Dec 2020. In some situations, insurers will even insist on a second opinion. 3. But you have to do both. Anything I am overlooking or need to add to my list of considerations? Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. Consult Fees In some cases, additional testing may be required. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. Everything seems to be on track to remove the cancer and be cured! I luckily found this webpage and I started reading everything I could get my hands on. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. Please enable it to take advantage of the complete set of features! No one at Hopkins has ever died of prostate cancer if he had Gleason 3 + 3 cancer." 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. 3. Greatest dimension 2cm. Most choose treatment they originally planned to follow, study finds. Surabhi Dangi-Garimella, PhD. Good Luck and God Bless everyone. Only took Motrin and Tylenol for pain after release. We had the 3T MRI (no coil) and MRI guided biopsy at Sperling in NY, and then had a 2nd Opinion done by Johns Hopkins. 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. Benign Processes: All rights reserved. When people recommend going to a Center of Excellence, believe them. It's a bit confusing since most experts now don't consider Gleason 6 to be a true cancer, so did i test positive in 2 cores or 4? Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. I opted to waive the biopsy, wait 1 year and test again. Allow yourself the time to seek multiple opinions. When to move from Active Surveillance to Treatment for Prostate Cancer? A fusion biopsy was performed in late May and I just received those results last Thursday. Yet none of my doctors ever mentioned it! See this image and copyright information in PMC. I am relatively new to this forum and trying to educate myself as to my best course of treatment. It got discussions started and questions answered. 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 . 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). feel the clock ticking. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. 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. advising or treating it. A enlarged prostate can also cause blockages in the urethra. 1.Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal, Cancer Statistics, 2019 CA Cancer J Clin. I retested in January 2019 and scored 4.20. * Both Sloan and Johns Hopkins admit that large discrepancies are unusual, yet both stand by their opinions. * Prostate volume: 22 cc -------------------------------------------------------- * Location: Right, anterior, apex, peripheral zone Generally, the symptoms can stabilize over time. Even at the age of 48, he thought I would be a good candidate for AS. Secondary Gleason grade: 4 decision on a single medical opinion or the first appointment you get, you may - T2 = 3/5 6. * 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! 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. * Size: 1.5 cm I also learned a lot more about the high undisclosed risk of side effects of various treatment plans. Find more COVID-19 testing locations on Maryland.gov. Question anemia. )As for side effectsI occasionally have some urgency/hesitancy having to pee. 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. Second opinions from urologists for prostate cancer: who gets them, why, and their link to treatment . Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. Those readings were reported on a second opinion by Dr. Epstein. I assume it is not free. Jonathan Epstein, MD received his doctorate from Boston University. The urologist offered surgery and radiation as options on 3/10 when we met. 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. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. 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. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! Accessibility Usually, patients obtain a second opinion after being referred to a second physician or to a special team of experts in a cancer center, called a multidisciplinary team. 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. Low post-void residual volume is So now things are getting exciting. I appreciate any comments or insight that anyone wants to share. 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. Enter the last name, specialty or keyword for your search below. curing cancer, prostate cancer questions johns hopkins hospital, josef issels wikipedia, cancer a second opinion a look at book by josef issels, coping with metastatic cancer cancer net, pdf americans health priorities curing cancer and, what is immunotherapy cancer research institute cri, cancer a second opinion a . There are so many different departments at Hopkins that I don't know the optimal department to contact. We are vaccinating all eligible patients. 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. It is very rare (<3% of all prostrate cancers) and potentially very lethal (one study showed that 59% of men in the study with Gleason scores of 5 had died within 3 years and it had metastasized in 13% of the remaining men). However, it also is possible to seek a pathology second opinion on your own, and it does not require an in-person office visit. Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 1. It took me awhile but minutes ago received my second opinion from Johns Hopkins. Hillen MA, Medendorp NM, Daams JG, Smets EMA. More medical freakouts. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. LESION 1 They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. Further, the two tumors in question have not really changed much in size for more than 2 years. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Are you sure you want to block this member? At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). The results of Oncotype came back and it was a bad report. Your Primary Care Physician referred you to your diagnosing urologist whom you now trust. Johns Hopkins second opinion - nothing found. * Should still go for a Johns Hopkins second opinion on the pathology or is that overkill since the first one was done at MSKCC? 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." Unfortunately, monetary incentives create biases that can work against patients best interests. -------------------------------------------------------- Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. Unbelievable that this happened!!! They want him to start radiation 25 sessions and chemo pills of Casodex 50 mg 28 pills. This is not true. More medical freakouts. - Perineural invasion is present Dr. Epstein has 744 publications in peer-reviewed literature and has authored 50 book chapters with a H-factor of 118. 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. Assessment categories for this lesion: I had my first of those 2 PSA tests last week and it dropped to 4.77. Would you like email updates of new search results? 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. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. You May Like: Prostate Radiation Treatment Side Effects. But I did speak to an oncologist who wanted to order Oncotype, which I did. LESION 2 Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. Urologists are trained as surgeons, radiation oncologists administer radiation, and medical oncologists provide cognitive oversight and general management of the cancer. Out of 12 cores, 9 are positive. I have posted here before, now with an update. PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Some men have minimal or no symptoms at all. Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. Details are here: 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. - Benign prostatic tissue These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Symptoms include leaking and discomfort. And should I treat prostatitis before FLA? Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. Prostate, right medial base: Youve just been diagnosed with prostate cancer. Patients may experience a fever or chills as a result of the infection. 6 A study at the Johns Hopkins Health System found it was 3.4 times more common in Black Americans than in White Americans. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. Fear, confusion and uncertainty set in. * Adjacent organ invasion: None. I had two no-risk, non-invasive tests: a Free PSA with an adverse score of 9% and a PCA3 test with a disappointing 41. Results: 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. Lesion #1 (index): PI-RADS v2.1 score 4, lesion measuring 10 mm centered at the right mid/apex posteromedial peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion; The low ADC value in this lesion increases the likelihood of Gleason grade group 2 or higher. 30%/40% or higher)? Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. Prostate, left lateral apex: Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Considering Prostate Cancer Clinical Trials? 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. A enlarged prostate can also cause blockages in the urethra. If the enlarged prostate is not completely removed, it will shrink. It starts many years ago. Benign Processes: 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. * Extracapsular extension: Possible involvement of the anterior His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. A diagnosis is usually reached within 3-5 days of your slides' arrival at Johns Hopkins. If pain is present, a digital rectal examination will reveal hard areas. Do I need a third opinion? Be sure to confirm your diagnosis at a center of excellence. restricted diffusion. Greetings gentlemen! Here are seven tips for seeking second opinions for prostate cancer: 1. 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. 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. The total number of cores with carcinoma is 3 If they have an enlarged colon, their physician can perform a TURP procedure. 3+4, 4+3, 4+3, 4+5 (1st read)Both docs are recommending surgery.PSMA CT Scan report:"BONES/BONE MARROW: There are sclerotic changes in the right pubic bone adjacent to the symphysis pubis and to lesser extent in the left pubic bone. The people were great. Recovery from Prostate Cancer | Bills Story. Unfortunately, what you do not realize may harm you! Do any of you have an opinion or actual experience with any of the three listed below? * Other 12 slides not sent Possible additional organ confined malignant lesion in right apex Because every patient is different, there are several ways to approach prostate cancer treatment. * Adjacent organ invasion: None. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. 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. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. I sent a message to my urologist requesting my slides be sent to Dr. Epstein at Johns Hopkins for a second opinion and I also requested an Oncotype DX test to get an idea of risk for my low teal or basic teal cancer. 2/13 PSA 5.2/fPSA 12.5% taken AFTER DRE (negative DRE) (lab #1) Dr. Jonathan Epstein of Johns Hopkins University Hospital. "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 . Intensity: min 148 / Max 459 And again, most of you tell me time is on my side, so I am comforted in hearing that. Have a condition that isnt improving or is getting worse, despite treatment. If pain is present, a digital rectal examination will reveal hard areas. Good Morning Brothers- Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. The margin of error is 1.4 percent, which is equivalent to 30,000 cancer diagnosis mistakes annually in the U.S. Of 6,171 biopsy slides sent since late 2008 for a second review at Johns Hopkins, pathologists disagreed with the diagnosis on 86 of them. 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. 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. 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. It can be caused by many factors, including infection and inflammation. I hope my story helps anyone out there just starting the process. 2. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) I just received a second opinion report from Johns Hopkins. A new study by researchers at the Johns Hopkins University has found that . If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. BONES: No suspicious osseous 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. My urologist has decided we'll go ahead with the MRI due to the continued elevated PSA scores, in addition to the overall PHI score. My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. Did robotic radical prostatectomy 1/25/12. My family physician for years told me that small increases PSA was common so when it went over 4 it didnt bother me and my Dr who was retiring, didnt say anything either. This is often the case when the primary physician advises an expensive treatment. My other option for treatment is either LDR or HDR brachytherapy. However, something is driving my PSA. Please don't hesitate to make any observations or ask questions. Greatest dimension 0.7cm . )As for side effectsI occasionally have some urgency/hesitancy having to pee. No two cases of prostate cancer are alike and an accurate diagnosisis critical to developing the best treatment plan. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. I would feel much more comfortable, if the numbers stay the same, being involved in a recognized Active Surveillance Program. I had been carefully watching as my PSA increased to 3.2 from 3.9 in summer 2010. Xia L, Talwar R, Chelluri RR, Guzzo TJ, Lee DJ. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. 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.
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johns hopkins prostate cancer second opinion