However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. I have completed all that is necessary to enter Johns Hopkins Second opinion and PTEN test program. We are vaccinating all eligible patients. Reasons for obtaining a second opinion from urologists. Overall PIRADS Score: 5/5 We can help with your case. Keeping a timeline and organized medical records is important because it can contribute to your treatment plan. 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. information. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. You think another treatment might be available. Symptoms include leaking and discomfort. 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. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us. 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. Want confirmation about a diagnosis or treatment. 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. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. )I contacted Dr Busch (still in Chattanooga at the time) and he called me directly to talk me off the ledge. There are three main types of doctors that manage prostate cancer: urologists, radiation oncologists, and medical oncologists. Most choose treatment they originally planned to follow, study finds. Not all men with Gleason 8-10 disease are going to do badly after Metastasis. The majority had lower risk tumors and clinical staging of 1 40% sought second opinions with about half having more than one reason Men seeking second opinions tended to be younger and better educated citing the need for more information as their reason. Dont Miss: New Treatments For Stage 4 Prostate Cancer. Consultation with your nurse care manager. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. Second opinion Biopsy came after FLA G-9. Treatment Advice: Sloans radiation oncologist says radiation treatment will likely be the same whichever pathologist report prevails, but may add hormone therapy for about 2 months. Medical record collection from doctors and hospitals. I certainly would - after all, there's a certain brotherhood bond here. 5. BASE DATA: 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. It was easy. What are your opinions of what that is, and where to get it? With world-renowned expertise, multidisciplinary specialistsand the latest data, we partner with you tomake informed decisions about managing your prostate cancer. The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. Many thanks for that. I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. Sometimes, you may find out about treatment options you didnt know were available. There are also many reasons why you may want to seek another opinion during the course of your cancer care. I have developed an "abscess" on my prostate. With AHN Cancer Institute, you already get a world-class cancer program with leading expertise, care, and outcomes. 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. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. LESION 1 Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. Second opinions from urologists for prostate cancer: Who gets - PubMed Now, I would like to send Radiology for a similar review. After a little experimenting I have been able to achieve a partial erection. Without the genomic test I have I lesion 3+3=6 and another, 3+4=7, with less than 5% pattern 4, and an MRI that shows no ECE, no other suspicious lesions and questionable cellular EPE based upon disagreement of pathologists. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. Thank you for your understanding and cooperation. Does 3+4 at some point typically evolve into 4+3 and also serve as a trigger point for moving from AS to treatment? 10. You think your doctor is underestimating how serious your cancer is. Prostate, left medial apex: It worked great (with negative pathology of the tissue) and fixed a lot of nasty symptoms and risks. If a targeted biopsy is planned, this lesion can be sampled at the same time. Secondary Gleason grade: 3 Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. I worked out every day. He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. I made the appointments. Five years ago I had a TURP. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. Please enable it to take advantage of the complete set of features! There is no extraprostatic extension. He also said perinueral invasion, but not extracapsular extension. Johns Hopkins Health - Second Opinions, Second Chances, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, High Blood Pressure May Take Its Toll on Your Kidneys. One of the bits of advice the group regularly dispenses is for men to get a second and even a third opinion if you have doubts about the first opinions rendered by your urologist, or your pathologist, or your radiologist, its always okay to seek out a second opinion. 180 days after treatment PSA was .50. 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. Johns Hopkins Health - Second Opinions, Second Chances - Hopkins Medicine I measure PSA frequently, and it is stable and slightly declining with the last score at 5.5. Johns Hopkins second opinion identified a PI-RADS 4 Mayo Phoenix also reviewed MRI prior to targeted biopsy. You May Like: Prostate Radiation Treatment Side Effects. The results of Oncotype came back and it was a bad report. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. IMPRESSION: Fear motivates you to want to treat this as soon as possible. For men with prostate cancer and who live in the United States, there are some highly regarded pathology labs from which you can obtain your second opinion. At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. (I must say that those low numbers concern me a bit.) 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. Potentially inaccurate results can lead to selection of the wrong type of therapy. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. * Adjacent organ invasion: None. That is literally the first time I heard that term other than seeing it in my pathology report. Second Opinions & Consultations - Johns Hopkins Pathology BONES: No suspicious osseous The percentage of tissue with carcinoma is 70% 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Slightly It works. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. 1. Many researchers believe PTEN present is a strong brake on My family doctor was alarmed because such a steep increase in prostate-specific antigen could be a sign of prostate cancer. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. 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. I am meeting with a multidisciplinary team of docs on March 18 at St. Joe's in Atlanta. If you're seeking a second opinion on treatment (see below), the specialist you choose often will be able to order a pathology second opinion for you, through his or her hospital's pathology department. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. the transition zone. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. 9. * Seminal vesicle invasion: None. How long do you have left? LESION 2 There is no one-size-fits-all treatment for prostate cancer. radiation, active surveillance, surgery, hormone therapy, and more. H. Prostate, lesion #2, core biopsy: The Journal of the American Board of Family Medicine published a study in 2017 that found that many patients do not get a second opinion outside of their PCPs original referral2. 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. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Cancer 2017;123:1027-34. Using an Ellipsoid Volume the dimensions would give you a volume of 20.44. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. Prostate Cancer Grading: More medical freakouts. (Scores above 55 have a greater than 50% chance of finding clinically significant cancer on a biopsy) The biopsy showed 2 or 3 cores containing HG PIN but no cancer. Both Drs and nurses knew what they were doing and had lots of experience. My strong preference would be to do FLA again and monitor. We specialize in minimally invasive treatments for prostate cancer such as: We place a high priority on sparing the nerves and tissue around the prostate whenever possible. Suspicion for malignancy left anterior base-to-apex transition zone; 3. Disclaimer. So, I made an appointment at Emory Proton Center (Atlanta, GA) and got their opinion. A report with the diagnosis will be faxed to your doctor. The prostates function is to create some of the fluid that insulates sperm cells found in semen. 5. However, older men 75 years were the least likely to report obtaining a second opinion due to dissatisfaction with their initial urologist. "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 . 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. Two weeks later I meet with my Johns Hopkins Dr. These findings are suspicious for degenerative changes however a subtle/early metastatic lesion cannot be excluded and continued periodic follow-up is recommended." 2016 American Cancer Society. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. 3. Now its easier than ever to get the answers you need and peace of mind you deserve. Every year I got a PSA and DRE during my annual physical. 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. And 2 cores from left apex of 3+3=6 with 10% involvement. This sounds to me like they're not familiar with the Oncotype DX test and makes me wonder how common is the test. However, just to be safe she schedules me for TRUS biopsy with the Urologist in another 6 weeks. Dont Miss: Is Coffee Bad For Your Prostate. How important is Oncotype DX test for Gleason 7? Here are some recent updates: Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade. It can: Confirm your original diagnosis and treatment plan Give you more detail about the type of breast cancer you have and stage it's in. Asking about other experience with conflicting Prostate Biopsy Opinions. 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. Race and ethnicity. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. I still have some urgency and frequency issues, but I am not complaining too bad. An accurate diagnosis is essential to ensure the most effective treatment. Thanks to all of you for sharing! Discover what's to love about Charm City for yourself. Studies show the clinical and financial benefits of obtaining a pathology second opinion. Does every biopsy provide a Gleason Score? Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. We are vaccinating all eligible patients. These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. 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. 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. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. 2020 Dec 1;3(12):e2028320. Urologists at the Johns Hopkins Brady Urological Institute can make the difficult process of deciding on a treatment plan easier. Here are the details: I was to follow up with my new Urologist (another surgeon) for 3 months PSA checks and annual 3T-MPMRI.My PSA checks were static and the next year's MRI looked just like the first. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. A blocked urethra can also damage the kidneys. Hi All, Had my PSA remained static I'd have remained on AS and had I grown a Target Lesion I'd have sought focal treatment.This science is emerging and only getting better. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. Benign Processes: It starts many years ago. Other: There is trace ascites in the mesosigmoid. My PSA went up from 3.5 post FLA (It was 7.2 pre-procedure) to 6.7 in 2021, so I went to another radiologist to do an MRI guided biopsy of the suspected area that was near the prior ablation zone. The percentage of Gleason grade 4 and/or 5 is 5 % Pathology report indicated additional presence of cells at right apex, but unclear whether intraprostatic incision or extraprostatic extension. 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. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. 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. Find more COVID-19 testing locations on Maryland.gov. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. 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. According to the doctor it is around 3 mm. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Your doctor is not sure what is wrong with you. My PSA over time has been creeping up over time (1.8 - 5/16, 1.0 8/17, 2.68 8/18, 2.9 12/18, 3.28 2/19, 3.01 8/19, 3.65 2/20, 3.31 6/20, 3.88 12/20) but I was frankly a bit shocked when I received word that I have cancer. The only prescriptions I take are for GERD (Protonix), cholesterol (Atvorstatin), and allopurinol for an episode of gout that I got while doing physical rehab for a bad tibia break (I shattered my tibia plateau 2/2020 and have pretty much recovered). * Adjacent organ invasion: None. And just this week, 1 YEAR post treatment, it is .46. Question anemia. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. 30%/40% or higher)? Value of Second Opinion in Prostate Cancer Uncertain, Says - AJMC 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. I would really love to hear from you. I suggest for all that hear, "you have cancer" that you seek more opinions! Diffuse probable benign peripheral zone changes limit evaluation for Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. TRANSPERINEAL MRI GUIDED BIOPSY RESULTS A week later had catheter removed and had no bladder leakage problems. 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. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. U.S. News & World Report ranked the institute #7in the country. Unfortunately, monetary incentives create biases that can work against patients best interests. If pain is present, a digital rectal examination will reveal hard areas. Thank you! Clipboard, Search History, and several other advanced features are temporarily unavailable. Eager to hear what everyone thinks or has anything they see in the report I wouldn't have thought of. 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. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. It works. If they have an enlarged colon, their physician can perform a TURP procedure. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. Be well. Forty percent of the men obtained a second opinion from urologists, most often because they wanted more information about their cancer or wanted to be seen by the best doctor . Greetings gentlemen! asymmetric central zone tissue more pronounced on the left. ---------------------------------------------------------- Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of 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. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. Slight BPH findings. HHS Vulnerability Disclosure, Help I was confident I was making the right decision. Johns Hopkins second opinion - nothing found. I assume it is not free. For this study, published in the journal Cancer, 2386 men in the greater Philadelphia area, who were diagnosed with prostate cancer between 2012 and 2014, responded to survey questions. We have a surgery date set up for the end of July at Johns Hopkins (our second opinion team).His stats:63yo, non smoker, 167lbs, Vegetarian/Vegan diet no other known health issuesWalks dogs for a living and cares for our small farmPSA 3.3 (Jumped from 1.6 in a year)Biopsy Scores 3+5, 4+3. In some situations, insurers will even insist on a second opinion. IMPRESSION: I was never under the misconception that I'd never have to do something, but I was going to wait until I needed to do something. Second opinion Johns Hopkins? - Prostate cancer The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. 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