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). 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. MRI June 2017 again at SMIL. 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%). A doctor may prescribe surgery or perform an endoscopic procedure. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. * 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! Reinterpretation of imaging scans and lab tests. He is the past president of the International Society of Urological Pathology. Jonathan Epstein, M.D. Diffuse probable benign peripheral zone changes limit evaluation for Anyway, would appreciate knowing how to contact Johns Hopkins. This condition causes pain in the lower back and groin area, and may cause urinary retention. Expert review of your case by a Cleveland Clinic specialist. In 2006 my PSA was .6. THANKS! The total number of cores identified is 3 Over 80,000 specimen cases are seen at Johns Hopkins each year. I opted to waive the biopsy, wait 1 year and test again. I am relatively new to this forum and trying to educate myself as to my best course of treatment. Three lesions: 1) GS 6 involving 30% of one core; 2) GS 6 involving less than 5% in one core; and 3) GS 6 involving less than 5% in another core. My prior Prolaris study (2018) before the FLA was very low risk. Six weeks later I have the biopsy in his office and a week later I get the results. Surgery took about 3 hrs. 1. 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. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Where Should I Go for a Second Opinion? - breast cancer Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. TZ zone more beneficial, but fairly large compared to whole gland and proximity to capsule edge would likely mean treatment would be suggested. 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. doi: 10.1001/jamanetworkopen.2020.28320. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. Knowing your stage and information specific to that stage makes you more medically sophisticated and enables you to navigate through the potential biases of surgeons and radiation therapists. If anyone has used him, please let me know what your experience was like. So the pathologist suggested a second opinion. 1. Has anyone else run into this where the gleason score is favorable, but the genomic (specifically Oncotype) test is not? Four weeks after a radical prostatectomy for prostate cancer, he was back in the pool. 2. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: Masks are required inside all of our care facilities. 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. restricted diffusion. Benign fibromuscular stroma; no prostatic glands are identified There were several areas of interest - but nothing in seminal vesicles, lymph, or bones. Second opinions from urologists for prostate cancer: Who gets - PubMed At the Johns Hopkins Medical Institutions, he is Professor of Pathology, Urology, and Oncology the recipient of the Reinhard Chair of Urological Pathology and Director of Surgical Pathology. I have completed an exhaustive research effort on Prostate Cancer and PCa treatments. AHN patients have unprecedented access to the Johns Hopkins Center for Fetal Therapy. Sought Johns Hopkins second opinion of pathology slides. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. I certainly would - after all, there's a certain brotherhood bond here. Did robotic radical prostatectomy 1/25/12. My strong preference would be to do FLA again and monitor. Careers. Good Morning Brothers- Because every patient is different, there are several ways to approach prostate cancer treatment. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. 10. Prostate, left anterior MRI lesion: Of course, my old school Urologist recommended surgeryHe, of course, knew the best robotic surgeons around.Anyway. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. The linear amount of tissue with carcinoma is 11 mm Olver I, Carey M, Bryant J, Boyes A, Evans T, Sanson-Fisher R. BMC Palliat Care. PCPs can be a great help to navigate the medical marketplace and provide an unbiased voice of reason when it comes to making hard choices. 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. Prostate dimensions: 4.1 x 2.8 x 3.4 cm Its in your best interest to ask for another look at a cancer diagnosisIf youve recently been diagnosed with cancer, its wise to ask for a second opinion on your pathology specimen.Johns Hopkins researchers with the Urological Pathology Consult Division, led by Jonathan Epstein, M.D., first reported on biopsy errors a decade ago, when they found a margin of error in prostate cancer diagnoses large enough to give them pause. So I initially thought this makes me a good candidate for AS. not hear all the viable treatment options or receive the most up to date However, something is driving my PSA. But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. It is OK to be scared. )As for side effectsI occasionally have some urgency/hesitancy having to pee. I didn't study for the test and it's possible some morning activities might have affected my test score :) Be well. !I'll try editing a previous post and see if it reads like a journal instead of creating a new thread every update.I just got my PSA results and the numbers are still trending in the right direction. 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. We specialize in minimally invasive procedures to treat BPH, including: For selected BPH patients, our specialists also perform transurethral resection of the prostate , a procedure that requires no incisions and has a high rate of success. Four had 60-70%, five have between 5-10%. You May Like: Prostate Radiation Treatment Side Effects. The treatment of prostate cancer has evolved tremendously. 5: Prostate, left medial apex They told me to expect a spike in my PSA sometime in the future, and they told me that studies are showing that a slow, steady decline in PSA is often indicative of superior results (whatever that means. 2020 Dec 1;3(12):e2028320. Background: Benign prostatic tissue Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. 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. They also determined there was extrapostatic extension because there was some fat in the sample that involved the cancer. I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). 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. Greatest dimension 2cm. We are vaccinating all eligible patients. Prostate cancer is a malignant (cancerous) tumor of the prostate, a gland found only in men. Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. They confirm everything except question whether one of the core samples is a 3+3 or 3+ 4. :) 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. -------------------------------------------------------- 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. Second opinion Johns Hopkins? - Prostate cancer 7 People with PN had an increased likelihood of: 6 Eating disorders Self-harm JAMA Netw Open. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. 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. 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. You feel healthy, you arent in pain, you A second opinion can accomplish a number of things. We are vaccinating all eligible patients. Best practices dictate that you obtain a second confirmatory pathology evaluation. Jonathan Epstein, MD received his doctorate from Boston University. 1st opinion"PYL PSMA PET/CT scan demonstrating foci of moderate to intense uptake in the prostate gland consistent with known prostatic cancer. My local urologist didnt want to schedule one because it he said it wouldnt change my treatment options, radiation or surgery. Blessings. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options available. 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. Identified an approximate 2 cm lesion of mostly Gleason 7 (3+4) with only 20% being 4, contained in prostate. Caused me to bleed heavily. You can find out by reviewing your plan or by reaching out to your insurance company. have no symptoms, and yet you have cancer? * PIRADS v2 Score: 3 A second opinion is a review of the cancer diagnosis and the treatment recommendations of the physician who is treating the cancer by another, independent physician. Either the patient or the primary physician can initiate the process of getting a second opinion. Bones: There is marketed marrow heterogeneity in the pelvic bones are not in the femoral heads. 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. 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. The https:// ensures that you are connecting to the Suspicion for malignancy left anterior base-to-apex transition zone; Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Dr stated that after seeing my muscles on the inside during operation he would have predicted this. Medical record collection from doctors and hospitals. This is often the case when the primary physician advises an expensive treatment. Symptoms include leaking and discomfort. I still have some urgency and frequency issues, but I am not complaining too bad. There is no extraprostatic extension. 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. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. Anyone else encounter something like this? Unauthorized use of these marks is strictly prohibited. If they have an enlarged colon, their physician can perform a TURP procedure. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Good Day Everyone. 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. Reasons for getting a second opinion include: You want to be sure you have explored all options. Got the fiducials placed, the Space-OAR gel placed, mold made, and had the pre-treatment MRI and CT Scan. Medical record collection from doctors and hospitals. The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. Natural history of progression after PSA elevation following radical An accurate diagnosis is essential to ensure the most effective treatment. BONES: No suspicious osseous 6 cancers that are the toughest to diagnose are prostate, bladder, head and neck, soft tissue, skin and lymph system. Bethesda, MD 20894, Web Policies In some situations, insurers will even insist on a second opinion. Compared with other men, African-American men and men with a family history of the disease are at higher risk of developing prostate cancer. Other: There is trace ascites in the mesosigmoid. 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. Get a Second Opinion 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. 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. Extracapsular extension: The prostatic capsule is preserved. About 80 percent of prostate cancers are diagnosed at a localized stage, which means that the cancer hasnt spread outside of the prostate. I have had a CT of the pelvic area - negative and a whole body bone scan - negative. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Utilize your primary care physicians as an un-biased resource to help you get second opinions from a range of specialists. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. ---------------------------------------------------------- No extraprostatic extension. And just this week, 1 YEAR post treatment, it is .46. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Surabhi Dangi-Garimella, PhD. - One separate small tissue fragment with prostatic adenocarcinoma, 0.5 mm in linear length I worked out every day. Either the patient or the primary physician can initiate the process of getting a second opinion. DRE is always normal. Watch: Are supplements good for prostate health? In severe cases, a catheter may be required to relieve the symptoms. 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. I was referred to a urologist and tested again in April at 4.40. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. I was disappointed that only TRUS was being used, but I did find out that this was for screening only and IF you pass screeningthey use MRI guided biopsy for post-ablation follow up. 5. 3. Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Cancer. 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. Johns Hopkins Prostate Cancer Doctors - HealthyProstateClub.com The average age at the time of prostate cancer diagnosis is about 66. I suggest for all that hear, "you have cancer" that you seek more opinions! Below is the link with instructions and the authorization form for you to use with your doctor. My current situation is age 67, no health issues, never had erectile dysfunction or incontinence, 6 tall, 175 lbs, generally fit and active. Your doctor is not sure what is wrong with you. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." Dont Miss: Screening For Prostate Cancer Icd 10. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. Who Should Request a Second Opinion? If you choose to be treated at Johns Hopkins, you may be able to begin treatment immediately. If I am rested, I find that I am more ready than if I am not. Second Opinions & Consultations - Johns Hopkins Pathology While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. You can call and speak with his assistant at: (410) 614-6330. Methods: But I've had trouble getting Dr. Chang's office to provide any patient referrals. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. Benign Processes: We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. Note respondents were able to, MeSH TRANSPERINEAL MRI GUIDED BIOPSY RESULTS The other samples produced 4 more positive cancer cores for a total of 7 of 12 positives. -------------------------------------------------------- Discover what's to love about Charm City for yourself. (PZ) - normal And when I attempt to ask questions about intradcutal, I get responses about how little is known about it because it's so rare or that it is controversial or that they're not familiar with the study I'm referencing. 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. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. 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 guess the PET scan will be the next step in what type of treatment options are in store.Has this occurred to anyone else? 6: Prostate, left medial base But I don't want to do a radical prostatectomy or radiation that would have large side effects now if the laser is a viable option given my data set. 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. Hello. P/ 310-827-7707 | F/ 310-574-4002 | MAIL@PROSTATEONCOLOGY.COM. We experienced information overload and decision/analysis paralysis. Greatest dimension 0.7cm . Some pathologists have more experience than others. It hasn't let me down. Brief MRI history. We prioritized treatment as AS, FLA/TULSA (if a lesion ever presented itself), and Proton Beam Radiation. Then about a month later I started 28 fractions of Proton Radiation.It was painless. - Benign prostatic tissue 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." Receiving a second opinion was not associated with perceived quality of prostate cancer care. Am I missing anything? Im immediately referred to Urologist. H. Prostate, lesion #2, core biopsy: Second opinion on biopsy slides - malecare.org Intensity: min 148 / Max 459 2: Prostate, right lateral base If the enlarged prostate is not completely removed, it will shrink. Interesting differences: 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) Centro Diagnostico Italiano , Milan, Italy, Manfred Dietel, M.D.Institute of Pathology Charit, Humboldt University of Medicine, Berlin, Germany, Jonathan I. Epstein, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Robert J. Kurman, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Elizabeth Montgomery, M.D.The Johns Hopkins Medical Institutions, Baltimore, MD, Manuel Sobrinho-Simes, M.D.University of Porto, Porto, Portugal, Ronald S. Weinstein, M.D.University of Arizona, Tuscon, AZ, Franco VisinoniMilestone Medical Technologies, Bergamo, Italy, Also Check: How Old Can You Be To Get Prostate Cancer. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. 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. Prurigo Nodularis Cancer: What's the Link? - Verywell Health Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. * Seminal vesicle invasion: None. I requested a second opinion from Johns Hopkins and they found 1 lesion was 3+3=6 and the second lesion was 3+4 =7, with less than 5% pattern 4. 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. 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. Reason was large volume of cancer (even though most of mine was Gleason 6), presence of Gleason 7 in biopsy and the rapidly increasing PSA. IMPRESSION: I have searched the country for intervential radiologist that perform FLA on the prostate. My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. 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.). They won't be offended, and they may even be able to recommend a specialist for you to see. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! I had my first of those 2 PSA tests last week and it dropped to 4.77. Youve just been diagnosed with prostate cancer. Had a little complication a day after release, excessive blood/clots in urine. They hesitated calling it a TARGET LESION, but scored it PIRADS 4. In order to receive appropriate treatment, patients must understand the treatment options that are available. Treatment decisions for prostate cancer should not be rushed due to a mistaken belief that immediate treatment is required. Hi JM "Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS).