Patient-Driven Second Opinions in Oncology: A Systematic Review. You May Like: Best Treatment For Intermediate Prostate Cancer. Two weeks later I meet with my Johns Hopkins Dr. Two 1cc tumors, gleason score 3+4 each, one in each lobe. Greatest dimension 0.7cm . We are vaccinating all eligible patients. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. I am 62 years old. So, I believe I made the right choice. And, even working in a fairly technical field myself, I was amazed at the technology and precision of that Proton Machine. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes. This fee includes: Recommended Reading: Radiation Therapy For Prostate Cancer. It got discussions started and questions answered. With world-renowned expertise, multidisciplinary specialists and the latest data, we partner with you to make informed decisions about managing your prostate cancer. Thank you! )As for side effectsI occasionally have some urgency/hesitancy having to pee. Overall PIRADS Score: 5/5 Getting a second opinion can sometimes lead to a complete change in diagnosis in non-cancerous growths, inflammatory disorders, infections, cancer and other conditions. He basically said it was possible, but that he did not agree. Perineural invasion is identified If I am rested, I find that I am more ready than if I am not. Here are the details: Your doctor is not a specialist in your type of . Dr also stated he was able to totally spare one of my nerves, but to get margin may have damaged one. 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. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. Even for men with faster growing, more aggressive prostate cancer, taking the time to seek a second opinion should be a priority. Johns Hopkins Medicine A commercially available genomic test may help oncologists better determine which patients with recurrent prostate cancer may benefit from hormone therapy, according to new research from the Johns Hopkins Kimmel Cancer Centerand 15 other medical centers. Atrophy 4. 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. 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. Be sure to confirm your diagnosis at a center of excellence. F. Prostate, left apex, core biopsy: Instructions for Second Opinion on Pathology (Gleason score) The .gov means its official. I find that when I'm trapped in the cockpit not able to use the bathroom for a long time is when I experience that most. Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. Good Luck and God Bless everyone. THANKS! - T2 = 3/5 Johns Hopkins said I have options of adjuvant radiation approach up to 3-4months or wait to see if there are two successive rises in PSA and then do "salvage" approach. They agreed with the PI-RADS 4. (Recommended by my oncologist, Dr. Mark Scholz.) The prostates function is to create some of the fluid that insulates sperm cells found in semen. Getting a Second Opinion The best time to seek a second opinion is before you start treatment. - 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) ORIGINAL MRI REPORT (local radiology group): Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. 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. Radiation oncologist of same group of doctors says to do IMRT (using Rapid ARC program) as precautionary treatment, regardless of PSA scores. 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.). Prostate Cancer | Johns Hopkins Medicine 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. Obviously the Covid 19 issue is playing a part in all of our decisions. 1. I made the appointments. HHS Vulnerability Disclosure, Help Second opinions are more likely to be comprehensive, or inclusive of every possible perspective, when performed in a cancer center with a multidisciplinary team, which usually includes surgeons, oncologists, radiation therapists, and sub-specialist oncologists. If these do not work, your symptoms could progress and become chronic. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion How long do you have left? Call us with any questions: 410-955-2405, ext. Mayo's report came back with the same PI-RADS 4 with the wording that it was more conspicuous but unchanged. Learn more through his bio: Progress in the field.In recent years, advancements in research have changed the way cancer is treated. I suggest for all that hear, "you have cancer" that you seek more opinions! I still have some urgency and frequency issues, but I am not complaining too bad. 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. I am an airline pilot with exposure to radiation, jet fuels/fumes, etc. 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. Who Should Request a Second Opinion? Diffusely decreased 9: Prostate, left anterior MRI lesion 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. Specimens Submitted: While I have three lesions, they are small and, without 3T mp MRI, might not have been discovered. very activerun/cycle 6 days a week 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 My Opinion? Get A Second Opinion | ZERO Prostate Cancer And just this week, 1 YEAR post treatment, it is .46. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. I am 65 and in excellent general health. Someone advised to always get my PSA checked at the same facility in order to make sure the same protocol and lab is used, is that critical? When I inquired with the oncologist that I had selected for my therapy before receiving the second opinion whether I would be a candidate for Active Surveillance considering the downgrading, she said 'no' due to the intraductal component. My thoughts focus on the fact that I have a disabled son who needs my care. 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. Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. Family history of prostate cancer. Results: I had no idea there were second opinions and I didn't have a clue about Genomic testing, or even genetic testing. U.S. News & World Report ranked the institute #7in the country. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different. 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. Getting A Second Opinion On Your Pathology Report - Cancer ABCs -------------------------------------------------------- Keep in mind that not all PCPs are knowledgeable about prostate cancer or know the skill levels of all the specialists in the field. In some situations, insurers will even insist on a second opinion. You May Like: Sbrt Radiation Therapy Prostate Cancer. Our collaborative processes also extend to our colleagues at Johns Hopkins Medicine, a world-wide leader in cancer research. 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. Those readings were reported on a second opinion by Dr. Epstein. It is OK to not understand all the terminology. After extensive discussion of his management options with his local urologist, primary care physician, and radiation oncologist, he also sought a second opinion at the Johns Hopkins Prostate Cancer Multidisciplinary Clinic at Sibley Memorial Hospital.The patient expressed an overwhelming desire to avoid surgery and any other invasive treatments. I'm currently in the process of getting an appointment set up with a Dr. Wang at UCLA. Second Opinion Results, Johns Hopkins biopsy reading of 2 slides sent by Sloan: Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Seminal vesicles are normal. 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. Just got my pathology results. FOIA Before Does that mean my Gleason Score based on my biopsy would be less than a Gleason 6? His second opinion just came back. Note respondents were able to, MeSH Get a Second Opinion What can a second opinion tell me? 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. 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 met with the radiologist 3/17 and he leans toward an IMRT radiation regimen of 5 or 20 sessions TBD combined with ADT (6-month shot but maybe 4 months was enough). I now have my list whittled down to 3. Are you sure you want to block this member? We experienced information overload and decision/analysis paralysis. radiation, active surveillance, surgery, hormone therapy, and more. Video consultation and written report from your expert. Thankfully, prostate cancer is extremely slow growing. For these reasons and others, it is advantageous to seek more than one opinion about how your cancer can be treated. 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. They seem to think it'll do the trick.I feel great and I am glad I chose this treatment path. The PSA Doubling Time parallels my Urologist Doubling Time (I keep changing Uro until I find one who makes sense)! We will give that a shot and see how it turns out. My other option for treatment is either LDR or HDR brachytherapy. Primary Gleason grade: 3 International Patients: How to Request a Remote Second Opinion There are also many reasons why you may want to seek another opinion during the course of your cancer care. Second Opinions - Bladder Cancer | Johns Hopkins Pathology My most recent biopsy resulted in two cores with Gleason 4+3=7 and one with 3+3=6. PSA that brought me to this was 7.1. It took me awhile but minutes ago received my second opinion from Johns Hopkins. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. But you have to do both. Some men may have an enlarged prostate but not notice it. Thanks to all of you for sharing! doi: 10.1002/cncr.30412. My questions are: The site is secure. 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. 2 of the 12 samples showed High Grade PIN and one area showed "suspicious for low-grade adenocarcinoma". The treatment of prostate cancer has evolved tremendously. * Prostate volume: 22 cc Wondering if any of the "gurus" here want to take a stab at looking at this and see if they agree that it says what I think it says (I will be following up with doctor(s) to get their opinion, and I waive all HIPAA rights by allowing this to be seen). Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. Conclusions: However, there are also many more options for treatment and these options are more complicated than in the past. __________________________________________________________________________July 2022I've neglected to make journal entries for a couple years, so I will recap below and continue with what I have done and what I have learned.In 2018, at the age of 48, after a routine physical that showed a PSA of (4.X) and after a TRUS biopsy, I was diagnosed with PCa. Seminal vesicles are normal. The average age at the time of prostate cancer diagnosis is about 66. )As for side effectsI occasionally have some urgency/hesitancy having to pee. Y'all are in my prayers! Medical record collection from doctors and hospitals. He spent an hour on the phone reassuring me that I didn't need to rush into anything, and they he'd love to scan me 6-8 weeks after my TRUS Biopsyhave to let the trauma and all the blood leave the prostate for a good image. The study included nearly 2,400 men in the Philadelphia area recently diagnosed with localized prostate cancer. My experience at Johns Hopkins was awesome. 2018 May;115:133-138. doi: 10.1016/j.urology.2018.01.048. Many researchers believe PTEN present is a strong brake on My urologist suggested a couple more PSA tests followed by an MRI. If the enlarged prostate is not completely removed, it will shrink. Because every patient is different, there are several ways to approach prostate cancer treatment. JAMA Netw Open. Epub 2010 Oct 20. An acute bacterial infection can cause a burning sensation. 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. Some docs say clean up the prostatitis while others tell me to avoid overuse of Cipro as it loses its effectiveness over time. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. 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. Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? Assessment categories for this lesion: Masks are required inside all of our care facilities. The urologist offered surgery and radiation as options on 3/10 when we met. We will then prepare a written recommendation regarding your treatment plans or options. And should I treat prostatitis before FLA? One to a 3+4=7 and the other to a 3+3=6. 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. In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. The neurovascular bundles are intact. Dont Miss: Is Coffee Bad For Your Prostate. It is still important to do your own research. Background: Their opinions are widely held to be definitive. The https:// ensures that you are connecting to the I've also read that some study's have shown that intraductal may be resistant to hormonal therapy, radiation and/or chemo. If a targeted biopsy is planned, this lesion can be sampled at the same time. Hope to hear from a bunch of people. G. Prostate, lesion #1, core biopsy: Some men may have an enlarged prostate but not notice it. I really just want the results of their innovative PTEN test. See this image and copyright information in PMC. Men often seek second opinions from urologists before they initiate treatment for their newly diagnosed prostate cancer. 24.5 BMI Epub 2017 Jun 12. 2019 Jan;69(1):7-34. doi: 10.3322/caac.21551. Benign fibromuscular stroma; no prostatic glands are identified Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. 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. 1. Details are here: Seeking a Second Opinion - American Cancer Society Natural history of progression after PSA elevation following radical 3: Prostate, right medial apex Recovery from Prostate Cancer | Bills Story. For a second opinion on the results of your prostate biopsy, there is no place better to get one than from the well known prostate pathologist, Dr. Jonathan Epstein at Johns Hopkins. He also stated that he would ONLY recommend FLA if done within a trial. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. Not all men with Gleason 8-10 disease are going to do badly after Prurigo Nodularis Cancer: What's the Link? - Verywell Health IMPRESSION: Your doctor is not sure what is wrong with you. And it is OK to have paralysis by over-analysis. Treatment must be chosen based on stage and your Our OB-GYNs, maternal-fetal medicine specialists, and pediatricians collaborate regularly with the Johns Hopkins team getting second opinions and access to hundreds of clinical trials. That said, I have some questions that I derived, keeping in mind that 99% of what I have learned since February has come directly from this group: JHs just said it was minimal less than 5%. Second opinions offer different things in different circumstances, Dr. Matasar says. Read Also: What Are The Signs Of Prostate Infection. The primary goal is to be cured with the least toxic, most effective approach. If they have an enlarged colon, their physician can perform a TURP procedure. There are so many different departments at Hopkins that I don't know the optimal department to contact. ---------------------------------------------------------- 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). Some pathologists have more experience than others. Out of 12 cores, 9 are positive. official website and that any information you provide is encrypted The percentage of tissue with carcinoma is 70% Find more COVID-19 testing locations on Maryland.gov. 3. 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. 6: Prostate, left medial base This shows very high signal intensity on the diffusion-weighted PROSTATE LESIONS: The biopsy took 3 samples from the targeted region plus 16 sextant. 5. 1: Prostate, right lateral apex His reasoning over the last couple of years is that the suspected lesion was not changing in size at all. This is a PI-RADS 5 lesion in These so-called grading and staging errors are more common and can affect how aggressively a patient is treated. A report with the diagnosis will be faxed to your doctor. Please enable it to take advantage of the complete set of features! Notice of Privacy Practices(Patients & Health Plan Members). Ask your PCP to refer you to several different types of treating doctors before making a treatment decision. He also said I would tolerate any option well based on my age and health. Grade Group: 1 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. notable articles of 2016 - Johns Hopkins Bloomberg School of 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. Slightly Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Good Day Everyone. So the pathologist suggested a second opinion. They find that one of my 5-10% Gleason 6 core is actually a 50% Gleason 7(3+4) and the MRI was so cloudy with blood from original biopsy they said they couldnt determine much. One of the problems with second opinions is that insurers may not cover the expense. 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. 2 cores from left base of 3+4=7 with only 5% involvement. What have your doctors told you? MEASUREMENTS: Surgical Delay and Pathological Outcomes for Clinically Localized High-Risk Prostate Cancer. 6. Prostate, right medial base: Sought Johns Hopkins second opinion of pathology slides. I would appreciate hearing from that 2.8% out there who have an intraductal component. A total of 2386 men responded to the survey (adjusted response rate, 51.1%). 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. !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. Potentially inaccurate results can lead to selection of the wrong type of therapy. 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. There is no extraprostatic extension. I recently sent my Pathology Slides to Dr. Epstein for a Second Review. It works. Fear motivates you to want to treat this as soon as possible. Pathology reports are subjective. Prostate, left lateral base: 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. Different institutions have different levels of experience when it comes to analyzing prostate biopsy samples and interpreting imaging results. Similarly, among those who received definitive treatment, second opinions were not associated with receiving surgery. Biopsy in 12/27/11 showed 3/14 cores, Gleason 6 with PSA of 4.5. 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. 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. 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. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . Second Opinion Pathology | MD Anderson Cancer Center have no symptoms, and yet you have cancer? You can find out by reviewing your plan or by reaching out to your insurance company. Y'all are in my prayers! That's the good news. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. I'm leaning towards SBRT. 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. Everything seems to be on track to remove the cancer and be cured! -------------------------------------------------------- PSA had increased to 5.4. Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. 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. Laparoscopic prostatectomy: The prostate is removed with a miniature telescopic instrument, which allows for a quicker recovery, Robotic surgery: This breakthrough technology, which often is used for prostatectomy surgery, requires only a few small incisions. No definitive evidence of distant metastatic disease is seen." 2/23 PSA 4.7/fPSA 12% taken for 4K score (lab #2) 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. I luckily found this webpage and I started reading everything I could get my hands on. 1st opinion. Send a Consult for Second Opinion | Johns Hopkins Pathology Find more COVID-19 testing locations on Maryland.gov. Even at the age of 48, he thought I would be a good candidate for AS. Did robotic radical prostatectomy 1/25/12. Most reputable HMOs can, however, deliver state of the art treatment for most cancers. 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. Should You Exercise When Youre Expecting? Though, for the most part the reports seem encouraging.I am curious if anyone has had something similar. Peripheral Zone: The peripheral zone is of normal homogeneous prolonged T2 and there are no suspicious focal areas of 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. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. 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. MY THOUGHTS AND ANYTHING DOCTOR NOTED: Without your support, I could easily have subjected myself to random biopsies that are risky, don't do a good job of finding lesions, and can mess up the clarity of the prostate for an MRI. Prostate Cancer Grading: