Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, The Sidney Kimmel Comprehensive Cancer Center. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. At a rectal exam 6/20 the urologist told me my prostate felt normal, not enlarged, nor did he feel any tumors. 2 cores from left base of 3+4=7 with only 5% involvement. A second opinion is part of the education process that is critical for many cancer patients. Treatment options include immunotherapy, 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. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). 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. We will then prepare a written recommendation regarding your treatment plans or options. 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. That being said, they can be a beneficial member of the treatment team. Good Luck and God Bless everyone. In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . Yet none of my doctors ever mentioned it! Even at the age of 48, he thought I would be a good candidate for AS. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision. If the enlarged prostate is not completely removed, it will shrink. My other option for treatment is either LDR or HDR brachytherapy. Also, Oncotype subsequently invalidated my results because they found in the history that I had a prior FLA. 1. Adenocarcinoma: Dr. said pirad-5 and to prepare for bad news and probably around a Gleason 7 and that he is rarely wrong. 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. So, I go one better, I call up Johns Hopkins and find a Dr who does DaVinci Prostate Surgery. 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. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. I luckily found this webpage and I started reading everything I could get my hands on. During the next 4 weeks I meet with the recommended Radiologist, and the two local surgeons. He never sought treatment for the injury. At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. Asking for your comments: A blocked urethra can also damage the kidneys. I have had a second opinion from Johns Hopkins that confirmed the initial pathology of gleason 3+4. This is a PI-RADS 5 lesion in My plan is to choose quality of treatment over cost of the treatment. I have been drinking out of an information fire hose. 1. I had my first of those 2 PSA tests last week and it dropped to 4.77. !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. One of the problems with second opinions is that insurers may not cover the expense. JHs just said it was minimal less than 5%. Best practices dictate that you obtain a second confirmatory pathology evaluation. Bring All Labs/Notes to Each Appointment. Suspicion for malignancy left anterior base-to-apex transition zone; At that point I agreed to the TRUS biopsy which I had on October 10, 2020. Time moves fast when dealing with cancer, but Doctors dont. What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! The total number of cores identified is 3 Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. 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. This is often the case when the primary physician advises an expensive treatment. 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. I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. Here's what JH says (same lesion). Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. I certainly would - after all, there's a certain brotherhood bond here. Prostate dimensions: 4.1 x 2.8 x 3.4 cm Make an appointment: 410-955-5222 Coordinating with your Treating Physician At the Breast Cancer Program at the Johns Hopkins Kimmel Cancer Center in Baltimore, MD, a second opinion requires only that you or your doctor send us your pathology slides, key medical records and signed paperwork requesting the opinion. Some men may have an enlarged prostate but not notice it. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. Im also wondering why no one has scheduled me for MRI to see what biopsy missed. I have searched the country for intervential radiologist that perform FLA on the prostate. The Radiation Oncologist said he would be comfortable waiting a little more, but he wasn't confident that I'd grow a target lesion, nor would I be able to wait years before having to do "something." It is OK to be scared. He basically said it was possible, but that he did not agree. * Extracapsular extension: None. Slight BPH findings. sharing sensitive information, make sure youre on a federal Nor did I have any idea that the 1 core had 20% involvement and <5% pattern 4 involvement. Who Should Request a Second Opinion? Also these lesions did not abut or touch the wall of the prostate. The study was published online Nov. 7 in the journal Cancer. The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. Just got my pathology results. Either the patient or the primary physician can initiate the process of getting a second opinion. MONDAY, Nov. 7, 2016 Second opinions have little impact on prostate cancer patients treatment decisions, new research suggests. You receive a secure, private online consultation without leaving home. * Sloan only sent partial cores, slides 1 and 4. I want to insure that the Imaging was read correctly and nothing was overlooked or missed. I now have my list whittled down to 3. It got discussions started and questions answered. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. So, I believe I made the right choice. Following application of the relevant exclusion criteria, 2365 respondents remained in the analytical cohort. - High grade prostatic intraepithelial neoplasia (HGPIN) We are vaccinating all eligible patients. I worked out every day. It also rules out Brachytherapy. It would be more convenient to use Mayo but I want the best practitioner regardless. Best wishes to all those whose concerns for the day are far more serious than mine. LESION 1 Benign fibromuscular stroma; no prostatic glands are identified I did a book review with his first book for several veterans groups including the Americal Division Veterans Organization which with I served at age 19. And in some cases, the information you gain during a second opinion consultation can even change your diagnosis. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) One core had 5%, one 20%, and one 40%. 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. 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. My understanding is that brachy is great for efficacy with less risk to the bowel and the same risk for incontinence and ED as other forms of radiation. Grade Group: 2 Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. They may defer to the recommendation of the specialist, or refer you to a doctor with limited prostate cancer experience. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. 2. 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. * Other 12 slides not sent We have sought a second opinion and all tests are being reviewed by that second team.My question has to do with the symphysis pubis. Unauthorized use of these marks is strictly prohibited. Sought Johns Hopkins second opinion of pathology slides. Atrophy In addition to providing a better understanding of your diagnosis, a second opinion can also shed new light on treatment options and give you confidence in how to proceed with your care. Axial T1-weighted images of the pelvis show no bony or bulky nodal disease. 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. 8. They did 9 patients in Phase I and there have been 12 so far in Phase II. With that alone, I would likely be a candidate for continued Active Surveillance. Over kill and redundancy I know, but it's my money, my prerogative. FAX 310-574-4002 BASE DATA: 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. At this point Im still ignorant about what I ought to be doing (MRI guided biopsy is what I should have gotten). Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. 2015 Feb;115(2):188-97. doi: 10.1111/bju.12665. NOTE: THINK THIS LOWERS MY PSA DENSITY SOME IF MY GLAND ISN'T a 17CC PEANUT! I frequently make a 2 hour car ride and I have to stop about 25% of the time and when I don't, the urgency is a bit more evident and with the urgency come some hesitancy, but not terrible. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. 4: Prostate, right medial base 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. U.S. News & World Report ranked the institute #7in the country. While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. Should You Exercise When Youre Expecting? A 1.4 cm lesion in the left, apex, anterior transition zone demonstrates conflicting T2 and DWI characteristics for PI-RADS classification - an indeterminate lesion. MRI RE-READ #3 (National Cancer Center of Excellence): In adjusted models, obtaining a second opinion was not associated with receipt of definitive treatment . 5. PSA that brought me to this was 7.1. In some situations, insurers will even insist on a second opinion. Thanks for considering. Surgeon wants next PSA in 3 months. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. 24.5 BMI Intensity: min 148 / Max 459 Lymph nodes: There is no suspicious lymphadenopathy in the pelvis. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. Everything seems to be on track to remove the cancer and be cured! lesion. Cancer ABCs recommends: Johns Hopkins Hospital in Baltimore, Maryland, specifically Dr. Jonathan Epstein. doi: 10.1136/bmjopen-2020-044033. Ask us questions on this webpage. 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. Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? 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. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. 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. Diffusely decreased Seminal vesicles are normal. Their opinions are widely held to be definitive. Their MRI was more sensitive and found there were actually 2 lesions close together that looked like one on the prior MRIs. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds. Our gynecologic pathology team can also help determine if the tumor is localized or has metastasized from another region of the body. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). What is NOT OK is quitting or avoiding the bad news, or handing the entire decision over to someone else.Good luck fellas! After a little experimenting I have been able to achieve a partial erection. We will give that a shot and see how it turns out. That's the good news. Now, I would like to send Radiology for a similar review. 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. 2.Tammy Jiang, Christian H. Stillson, Craig Evan Pollack, Linda Crossette, Miupdachelle Ross, Archana Radhakrishnan, and David Grande, How Men with Prostate Cancer Choose Specialists: A Qualitative Study, Journal of the American Board of Family Medicine: JABFM, 30(2), (2017): 220229. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. Low post-void residual volume is PROSTATE LESIONS: The prostate gland is slightly enlarged secondary to transition zone hyperplasia (25cc total) He turned to the Top Gun of Prostate Pathology: Jonathan Epstein, MD, the guru of Gleason scoring at Johns Hopkins University in Baltimore. They replied they are sending the slides but they said they're looking into the DX test and will get back to me once they have that information. First of all we would like to emphasize that the health of our employees, our patients and their relatives is our first priority. Overall, nearly 80% of men received definitive treatment 76.5% of men who obtained a second opinion from a urologist received definitive treatment compared to 81.6% who did not . C. Prostate, right apex, core biopsy: PSA was 3.0 in 2011 and rose to 6.0 in late 2013. Surgery seems like overkill for me with too many risks for incontinence and permanent ED, am I overlooking something? 5. And again, most of you tell me time is on my side, so I am comforted in hearing that. ADC: mean 879 / median 839 / st dev 223 Unfortunately, the 12/20/20 PSA reading was higher and that led to an MRI on 2/2/21 when two lesions were discovered. 3. There are so many different departments at Hopkins that I don't know the optimal department to contact. 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. The site is secure. Masks are required inside all of our care facilities. I did ask some questions about the study, if anyone is interested. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. Have a condition that isnt improving or is getting worse, despite treatment. Expert review of your case by a Cleveland Clinic specialist. Men need to be educated on all treatment options to protect themselves from a biased industry. When to move from Active Surveillance to Treatment for Prostate Cancer? - DWI-ADC = 4/5 I had a very bad experience with an incompetent nurse that did a catheter change. 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. Check Biopsy and Imaging Results for Accuracy. Good Morning Brothers- Numerous publications show the clinical and economic benefits of obtaining a second opinion for Pathology specimens. I assume the data on gleason scoring is much more robust/reliable than genomics as it has been around longer and used more extensively. I say bullshit to them. Would you like email updates of new search results? Accessibility 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. A blocked urethra can also damage the kidneys. Comments appreciated, * Seminal vesicle invasion: None. We experienced information overload and decision/analysis paralysis. 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 . 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. A newly published paper by Fischer et al. 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.
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