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. Second opinion Biopsy came after FLA G-9. - Prostatic adenocarcinoma, Gleason score 3+4=7 (grade group 2, pattern 4: 10%) involving 2 of 2 cores (medial core: 0.5 mm, 4%; lateral core: 1.5 mm, 10%), 1 mm to the blue inked tissue edge (the closer) He has had a nagging "groin injury" for may years (he played pick up basket ball until he got injured) and we are now wondering if this could be the source of that recurring ache. We can help with your case. 3/5 Hello. Some specialists have more expertise and more experience than others. Prior to the results, the oncologist said that the literature shows that a 3+4=7 with less than 5% pattern 4 behaves just like a 3+3=6 and basically is an indolent tumor. Yet none of my doctors ever mentioned it! 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. It may be a new cancer, but it is more likely a recurrence since it is really near the ablation zone. It works. Metastasis. Consultation with your nurse care manager. After all, it seems like good idea to deal with your cancer sooner rather than later. This approach helps to decrease side effects that can affect a patients quality of life, such as erectile dysfunction, incontinence or other urinary-tract symptoms. Had third MRI in July 2019 this time at Mayo which I believe does a better job than SMIL. 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. -------------------------------------------------------- and I have already proven to myself that my body is good at cell mutation, so I wanted to be careful.At the 3 year mark (6 months after last MRI), my PSA spiked to > 6. 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. 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. After applying exclusion criteria, the final analytic cohort included 2365 respondents. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. Want confirmation about a diagnosis or treatment. MRI RE-READ #2 (VERY VERY well respected radiologist): 10: Prostate, right anterior MRI lesion -------------------------------------------------------- I also had my PTEN test by META-MARK ( I don't have much to say about how I was treated by MM, but I won't be using their services again). Learn MoreFor more information about pathology second opinions, visit pathology.jhu.edu or call 877-546-1872. Have been told a health condition is not treatable. There are also some cases of the test showing no depletion but being wrong. After a second opinion from both Johns Hopkins and Stanford, the two 4+3's were downgraded. I have been drinking out of an information fire hose. * PIRADS v2 Score: 5 A blocked urethra can also damage the kidneys. Unauthorized use of these marks is strictly prohibited. If they have an enlarged colon, their physician can perform a TURP procedure. Primary Gleason grade: 3 not hear all the viable treatment options or receive the most up to date While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. But I refuse to sit still, I continue to research and to plan, as best I can. I still have some urgency and frequency issues, but I am not complaining too bad. 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. 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. With The Clinic by Cleveland Clinic, patients have access to Cleveland Clinics 3500 specialists. Many men name the diagnosing urologist as their treating doctor and do not seek other opinions. I was confident I was making the right decision. Unlike pathology labs in most hospitals, Jonathan Epstein's lab at Johns Hopkins has pathologists who specialize in reading prostate tissue samples. The researchers did not include more minor errors in rating how fast-growing and how advanced a cancer was. How to Get a Second Opinion Our team at Johns Hopkins has a dedicated service to interpretation of brain tumors and render second opinions on a daily basis. In unadjusted analyses, younger men , men with college-level education , and privately insured men and Medicare ) were more likely to obtain second opinions . 1st opinion"Nonspecific sclerotic change of the right pubic bone with low-level radiotracer activity, favor degenerative change rather than osseous metastasis." I would really love to hear from you. I just received a second opinion report from Johns Hopkins. The researchers also found that patients who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to do so by family or friends were more likely to undergo surgery. I tried to send the samples out for genetic testing to Prolaris and Decipher, but there was an ordering error and they never went thru. I'm leaning towards SBRT. My dad 82 was diagnosed last week with prostate cancer with high PSA 100 and GLEASON: ( 4 + 4 ) = 8 / 1 0 , he had the PET Ga-68 PSMA image Friday and today we found out the result is stage 4 Metastatic lesions in the bone pelvic area. Both of which are normal volumes, the Bullet Volume is considered more precise in prostates smaller than 55ml. 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). When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. Unfortunately, what you do not realize may harm you! Negative cancer in lymph nodes, seminal vesicles, and all margins. Mohamad Allaf, M.D., answers questions about prostate cancer diagnosis and treatment options and discusses robotic prostatectomy at Johns Hopkins. * Location: Right, anterior, apex, peripheral zone Is the destruction of my prostate inevitable and necessary for my survival (my understanding is that both surgery and radiation will do this)? 2. I had a telemed session with Dr. Chang, and it sounds like a pretty simple procedure, with urinary side effects that resolve pretty quickly. Even at the age of 48, he thought I would be a good candidate for AS. With no travel needed and no red tape, its easy to get a second opinion, all from the comfort of your home. IMPRESSION: Im also wondering why no one has scheduled me for MRI to see what biopsy missed. But in the spirit of disclosure for those of you with BPH a TURP can complicate a future Radical Prostatectomy (or possibly Cryo) and increase the risk of side effect risks. 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%). But, after 4 drinks or if I'm tired/jet lagged I find that sleep is more appealing than sex. Benign prostatic tissue __________________________________________________________________________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. What have your doctors told you? Now, I would like to send Radiology for a similar review. Benign fibromuscular stroma; no prostatic glands are identified The Radiation Oncologist knew of Dr Busch (by now in Alpharetta, GA) and spoke highly of him. 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." 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. advising or treating it. One core had 5%, one 20%, and one 40%. An increase of 1.1 in 3 months is not good news. I suggest for all that hear, "you have cancer" that you seek more opinions! 4. Consult Fees In some cases, additional testing may be required. If you are diagnosed with a urologic cancer, including but not limited to the prostate, bladder, kidney, and testicular or urinary tract, its important to consider a second opinion. Hope to hear from a bunch of people. And if so, what does being accepted in a AS program look like, do I need to be present at their location? Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. Dr. Jonathan Epstein of Johns Hopkins University Hospital. Comments appreciated, Second opinions offer different things in different circumstances, Dr. Matasar says. Thank you for your understanding and cooperation. 6: Prostate, left medial base In adjusted analyses, however, only age and education were significantly associated with obtaining second opinions from urologists. It is OK to not understand all the terminology. Anyone else encounter something like this? 7. HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. Through the AHN Cancer Institute, you benefit from personalized treatment in your community, close to home, from your dedicated care team. 10. 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. He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms. Many thanks for that. It is OK to be scared. Steve, Groucho was wrong when he said "i don't want to belong to any club that would have me as a member." Disclaimer. 4 Get a Second Opinion Dr. Jonathan Epstein explains the benefits of getting a pathology second opinion FOIA 4.5 year journey (18 months post proton beam), 4.5 Year Update (18 month post Proton Beam). government site. He never sought treatment for the injury. 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. If the enlarged prostate is not completely removed, it will shrink. This is not true. It was easy. Because I had an implant in my ear, they would only give me a 1.5T MRI. You receive a secure, private online consultation without leaving home. 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. Video consultation and written report from your expert. Whether you want expert confirmation, lack understanding or confidence in your treatment plan, have a rare or unusual type of cancer, your cancer isnt responding to current treatment its reassuring to know that you have options through a second opinion. What are your opinions of what that is, and where to get it? Estimated prostate volume of 35 cc with an estimated PSA density of 0.11 ng/mL/cc. mail@prostateoncology.com, 7 Tips for Seeking Second Opinions For Men with Prostate Cancer. So my question for you is have you ever heard of PRECISE and if so what should I make of it? How could this compare using only partial slide re-reading? Since I have gotten so much out of this forum, I thought Id provide my story to help others. The linear amount of tissue with carcinoma is 11 mm The urologist/surgeon indicated that other forms of treatment like TULSA are not options since my cancer is multifocal. The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. Dont Miss: Function Of The Prostate Gland And Seminal Vesicles. When you get a diagnosis of breast cancer from your doctor, its not uncommon to get a second opinion. I have seen numerous urologist for their opinion and all of them want to cut and radiate and give me hormones. 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). If you are considering undergoing a specialized treatment, such as cancer surgery, within your HMO, it is important to inquire about the number of such procedures performed each year by the HMO and the results. Then about a month later I started 28 fractions of Proton Radiation.It was painless. Not all cancers are the same and not all treatment plans are absolutely clear. Remember if you ship them include the following information: You May Like: Blood In Urine After Prostate Biopsy. * Adjacent organ invasion: None. Johns Hopkins Medical Laboratories 1620 McElderry St. Reed Hall Rm 315 Baltimore, MD 21205 Fax (410) 614-7712 Phone (410) 955-2405 8 am - 5 pm Normal LAB hours are: 5:30 am - 4:30 pm Mon-Fri 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. You know - urinary incontence, erectile dsyfunction, and exhaustion (hormones) are not my cup of tea. A report with the diagnosis will be faxed to your doctor. 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. 1st opinion. B. Prostate, right mid, core biopsy: Second Opinions An accurate diagnosis is essential to ensure that the correct and most effective treatment is given. The symptoms of acute bacterial prostatitis are similar to those of CPPS. It's really that simple! Any score above 55 has a greater than 50/50 chance of finding clinically significant cancer. 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. 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). If anyone has used him, please let me know what your experience was like. Enter the last name, specialty or keyword for your search below. Does every biopsy provide a Gleason Score? * Prostate size: 3.9 x 2.8 x 3. cm This may include imaging, blood tests, prior treatment, and pathology reports. The results of the MRI said they found a PYRAD 5 lesion, but did not find any cancer outside prostate. Its gone.I have been advised to have a Axumin Pet scan as follow up as the first pathology report indicated perineural invasion present as well as probable introductal carcinoma. At that point I agreed to the TRUS biopsy which I had on October 10, 2020. However, many insurance and health care companies do pay for such opinions and acknowledge the importance of second opinions. I am relatively new to this forum and trying to educate myself as to my best course of treatment. 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. Pingback: PROSTATE PROS Episode 6: Breakthroughs in Radiation PROSTATE ONCOLOGY SPECIALISTS, Pingback: Like Man, Im Tired (Of Waiting): The How-to Guide for Men with Prostate Cancer PROSTATE ONCOLOGY SPECIALISTS, Your email address will not be published. F. Prostate, left apex, core biopsy: 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." 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. It is OK to be overwhelmed with info. 5/10 PSA 4.2/fPSA 9% taken at MSKCC (lab #3) Second Opinions (Adults) For stem cell transplant, please call 1-773-702-1994. The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. -------------------------------------------------------- I also changed my diet to plant based food, started juicing, and started taking supplements (think Turmeric, Green Tea, etc.). * Adjacent organ invasion: None. 2011 Feb;29(1):3-9. doi: 10.1007/s00345-010-0602-y. A second opinion can accomplish a number of things. 1. First 6 week PSA is undetectable. The percentage of Gleason grade 4 and/or 5 is 5 % They are not objective. While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Your doctor is not sure what is wrong with you. Masks are required inside all of our care facilities. * Location: Left, anterior, base to apex, transition zone I fear limiting myself to an inferior treatment because the people I talk to have hammers, therefore everything must be a nail. If youve received a new diagnosis or arent seeing results from your current treatment plan, a second opinion can help you move forward with confidence. Patient preferences and urologist recommendations among local-stage prostate cancer patients who present for initial consultation and second opinions. Especially opinions other than those of the first Urologist you see. But, ultimately decided on whole gland treatment using Proton Beam Radiation.So. And by FAA Aeromedical Ruling, I'd need a few post procedure reports before being cleared to fly again.) Getting a Second Opinion The best time to seek a second opinion is before you start treatment. And collaborating with Johns Hopkins Medicine means we can provide you with second opinions, streamlined and guided access to clinical trials, and a proven track record of excellence in care. Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. MEASUREMENTS: A new study by researchers at the Johns Hopkins University has found that . An acute bacterial infection can cause a burning sensation. Benign fibromuscular stroma; no prostatic glands are identified -------------------------------------------------------- The all-inclusive cost for a virtual second opinion for patients in the U.S. is $1,850. Prostate Cancer Grading: My girlfriend lives 2 blocks from the Emory Proton Clinic.We prayed on it and overthought the crap out of it. It would be more convenient to use Mayo but I want the best practitioner regardless. transition zone. 2016 American Cancer Society. doi: 10.1136/bmjopen-2020-044033. The results were ambiguous. Your current doctor will frequently suggest a second opinion, if only to confirm the recommended course of action. 3 months has passed, and its time for a PSA and a plan to have an MRI. I really liked the new group I went to as they identified the lesion right away, unlike the radiologist who performed the first procedure, and they also have a urologist on staff as well monitoring everything. Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. During your visit, our specialists will review your medical records, diagnostic tests and other information provided by you or your current physician. SO. 180 days after treatment PSA was .50. Now its easier than ever to get the answers you need and peace of mind you deserve. In order to receive appropriate treatment, patients must understand the treatment options that are available. - Benign prostatic tissue Wow, I sound like a snob now! HMO members may also be discouraged from trying expensive treatments that have only a small chance of success, even if that chance is real. After a little experimenting I have been able to achieve a partial erection. 2017 Oct;22(10):1197-1211. doi: 10.1634/theoncologist.2016-0429. 3. 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. I worked out every day and it wasn't until the last week did I feel a bit fatiguedand experience a bit of urgency and hesitation having to peeflowmax fixed that right up!90 days after treatment my PSA came in at .56. The more accurate the information we have, the better our treatment decisions. Either the patient or the primary physician can initiate the process of getting a second opinion. Best practices dictate that you obtain a second confirmatory pathology evaluation. I appreciate any comments or insight that anyone wants to share. Masks are required inside all of our care facilities. 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. Masks are required inside all of our care facilities. - Johns Hopkins Medicine -- Get a Second Opinion * Prostate volume: 22 cc Anything I am overlooking or need to add to my list of considerations? Get a Second Opinion What can a second opinion tell me? You're at greater risk if you're Black or of African ancestry. If youve received a new cancer diagnosis or arent seeing results from your current treatment plan, an expert second opinion can help you move forward with confidence. Based on the results, our experts can provide you with an individualized treatment plan before you leave. Diffusely abnormal appearance of the prostate may reflect prostatitis, which can obscure underlying prostate cancer. Getting a second opinion on a diagnosis can reverse a diagnosis or alter the treatment plan. Read books and realize as soon as they are published, they are outdated. Note respondents were able to choose more than one reason. 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. This suggests that for some men, second opinions offer a way to pursue the treatment they already planned on, rather than to explore other treatment options, according to study authors Dr. Archana Radhakrishnan, of Johns Hopkins University in Baltimore, and her colleagues. Treatment options include immunotherapy, This is why the prostate is important to the body. Hello everyone. Anyway, would appreciate knowing how to contact Johns Hopkins. Confused about Pathology report and course of action, Phone Number for John's Hopkins Radioogy Second Opinion. Adenocarcinoma: My goals are to control PCa, to minimize side effects, and to keep options open in the future. Here are the details: Research was mixed on PINS, but in those days, many doctors saw them as likely to develop into cancer. The ADT has daunting side-effects but he said offers some improved chances of eradication, any long-term downsides that I should consider? 5. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. Being in Wisconsin, my insurance gives me the option of two hospitals to manage me. I trust the second opinion Dr. Bush gave. Over 80,000 specimen cases are seen at Johns Hopkins each year. Possible additional organ confined malignant lesion in right apex Some of the more common treatments that you and your doctor may discuss include: Prostate cancer experts at the Brady Urological Institute have created tools that help patients and doctors across the world assess risk and make treatment decisions.